Peripheral Vascular Disorders

The male client is diagnosed with Guillain-Barré (GB) syndrome and is in the intensive care unit on a ventilator. Which cardiovascular rationale explains implementing passive range-of-motion (ROM) exercises? 1. Passive ROM exercises will prevent contractures from developing. 2. The client will feel better if he is able to exercise and stretch his muscles. 3. ROM exercises will help alleviate the pain associated with GB syndrome. 4. They help to prevent DVTs by movement of the blood through the veins.

1 ***1. A complication of immobility after surgery is developing a DVT. This client with left calf pain should be assessed for a DVT.* 2. This is an expected finding. 3. Clients who require an open cholecystectomy frequently are discharged with a T-tube. This client needs to know how to care for the tube before leaving, but this is not a priority over a possible surgical complication. 4. This is expected for this client. TEST-TAKING HINT: In priority-setting questions, the test taker must decide if the information in the answer option is expected or abnormal for the situation. Based on this, options "2," "3," and "4" can be eliminated.

The nurse is teaching a class on coronary artery disease. Which modifiable risk factor should the nurse discuss when teaching about atherosclerosis? 1. Stress. 2. Age. 3. Gender. 4. Family history.

1 ***1. A modifiable risk factor is a risk factor that can possibly be altered by modifying or changing behavior, such as developing new ways to deal with stress.* 2. The client cannot do anything about getting older, so it cannot be modified. 3. Gender is a risk factor that cannot be changed. 4. Having a family history of coronary artery disease predisposes the client to a higher risk, but this cannot be changed by the client.

The nurse is discussing the pathophysiology of atherosclerosis with a client who has a normal high-density lipoprotein (HDL) level. Which information should the nurse discuss with the client concerning HDL? 1. A normal HDL is good because it has a protective action in the body. 2. HDL lipoprotein level measures the free fatty acids and glycerol in the blood. 3. HDLs are the primary transporters of cholesterol into the cell. 4. The client needs to decrease the amount of cholesterol and fat in the diet.

1 ***1. A normal HDL level is good because HDL transports cholesterol away from the tissues and cells of the arterial wall to the liver for excretion. This helps decrease the development of atherosclerosis.* 2. The normal HDL level was the result of a test measuring high-density lipoproteins, not free fatty acids and glycerol in the blood, which are measured by the serum triglyceride level. Triglycerides are a source of energy. 3. Low-density lipoproteins (LDLs), not HDLs, are the primary transporters of cholesterol into the cell. They have the harmful effect of depositing cholesterol into the walls of the arterial vessels. 4. A normal HDL level is good and the client does not need to change the diet.

Which assessment data would warrant immediate intervention by the nurse? 1. The client diagnosed with DVT who complains of pain on inspiration. 2. The immobile client who has refused to turn for the last three (3) hours. 3. The client who had an open cholecystectomy who refuses to breathe deeply. 4. The client who has had an inguinal hernia repair who must void before discharge.

1 ***1. A potentially life-threatening complication of DVT is a pulmonary embolus, which causes chest pain. The nurse should determine if the client has "thrown" a pulmonary embolus.* 2. An immobile client should be turned at least every two (2) hours, but a pressure area is not life threatening. 3. This is expected in a client who has a large upper abdominal incision. It hurts to breathe deeply. The nurse should address this but has some time. The life-threatening complication is priority. 4. Clients who have had inguinal hernia repair often have difficulty voiding afterward. This is expected.

The nurse is unable to assess a pedal pulse in the client diagnosed with arterial occlusive disease. Which intervention should the nurse implement first? 1. Complete a neurovascular assessment. 2. Use the Doppler device. 3. Instruct the client to hang the feet off the side of the bed. 4. Wrap the legs in a blanket.

1 ***1. An absent pulse is not uncommon in a client diagnosed with arterial occlusive disease, but the nurse must ensure that the feet can be moved and are warm, which indicates adequate blood supply to the feet.* 2. To identify the location of the pulse, the nurse should use a Doppler device to amplify the sound, but it is not the first intervention. 3. This position will increase blood flow and may help the nurse palpate the pulse, but it is not the first intervention. 4. Cold can cause vasoconstriction and decrease the ability to palpate the pulse, and warming will dilate the arteries, helping the nurse find the pedal pulse, but it is not the first intervention.

Which assessment data would require immediate intervention by the nurse for the client who is six (6) hours postoperative abdominal aortic aneurysm repair? 1. Absent bilateral pedal pulses. 2. Complaints of pain at the site of the incision. 3. Distended, tender abdomen. 4. An elevated temperature of 100 ̊F.

1 ***1. Any neurovascular abnormality in the client's lower extremities indicates the graft is occluded or possibly bleeding and requires immediate intervention by the nurse.* 2. The nurse would expect the client to have incisional pain six (6) hours after surgery, so this is not priority over a complication. 3. The nurse would expect the client to have a distended, tender abdomen as a result of postoperative edema. 4. A slightly elevated temperature would not be uncommon in a client who has had surgery.

The client had an abdominal aortic aneurysm repair two (2) days ago. Which intervention should the nurse implement first? 1. Assess the client's bowel sounds. 2. Administer an IV prophylactic antibiotic. 3. Encourage the client to splint the incision. 4. Ambulate the client in the room with assistance.

1 ***1. Assessment is the first part of the nursing process and is the first intervention the nurse should implement.* 2. Administering an antibiotic is an appropriate intervention, but it is not priority over assessment. 3. The client should splint the incision when coughing and deep breathing to help decrease the pain, but this intervention is not priority over assessment. 4. Ambulating the client as soon as possible is an appropriate intervention to help decrease complications from immobility, but it is not priority over assessment.

The nurse is discussing the importance of exercising with a client who is diagnosed with CAD. Which statement best describes the scientific rationale for encouraging 30 minutes of walking daily to help prevent complications of atherosclerosis? 1. Exercise promotes the development of collateral circulation. 2. Isometric exercises help develop the client's muscle mass. 3. Daily exercise helps prevent plaque from developing in the vessel. 4. Isotonic exercises promote the transport of glucose into the cell.

1 ***1. Collateral circulation is the development of blood supply around narrowed arteries; it helps prevent complications of atherosclerosis, including myocardial infarction, cerebrovascular accidents, and peripheral vascular disease. Exercise promotes the development of collateral circulation.* 2. Isometric (weight-lifting) exercises help develop muscle mass, but this type of exercise does not help decrease complications of atherosclerosis. 3. A low-fat, low-cholesterol diet may help decrease the plaque formation, but exercise will not do this. 4. Isotonic exercises, such as walking and swimming, promote the movement of glucose across the cell membrane, but this is not why such exercises are recommended for prevention of atherosclerotic complications.

The client diagnosed with essential hypertension asks the nurse, "I don't know why the doctor is worried about my blood pressure. I feel just great." Which statement by the nurse would be the most appropriate response? 1. "Damage can be occurring to your heart and kidneys even if you feel great." 2. "Unless you have a headache, your blood pressure is probably within normal limits." 3. "When is the last time you saw your doctor? Does he know you are feeling great?" 4. "Your blood pressure reflects how well your heart is working."

1 ***1. Even if the client feels great, the blood pressure can be elevated, causing dam- age to the heart, kidney, and blood vessels.* 2. A headache may indicate an elevated blood pressure, but the client with essential hypertension can be asymptomatic and still have a very high blood pressure reading. 3. This response does not answer the client's question as to why the doctor is worried about the client's blood pressure. 4. The blood pressure does not necessarily reflect how well the heart is working. Many other diagnostic tests assess how well the heart is working, including an electrocardiogram (ECG), an ultrasound, and a chest x-ray.

The client is admitted for surgical repair of an 8-cm abdominal aortic aneurysm. Which sign/symptom would make the nurse suspect the client has an expanding AAA? 1. Complaints of low back pain. 2. Weakened radial pulses. 3. Decreased urine output. 4. Increased abdominal girth.

1 ***1. Low back pain is present because of the pressure of the aneurysm on the lumbar nerves; this is a serious symptom, usually indicating that the aneurysm is expanding rapidly and about to rupture.* 2. If any pulses were affected, it would be the pedal pulses, not the radial pulses. 3. Decreased urine output would not indicate an expanding AAA, but decreased urine output may occur when the AAA ruptures, causing hypovolemia. 4. The abdominal girth would not increase for an expanding AAA, but it might increase with a ruptured AAA.

The nurse is discussing discharge teaching with the client who is three (3) days postoperative abdominal aortic aneurysm repair. Which discharge instructions should the nurse include when teaching the client? 1. Notify HCP of any redness or irritation of the incision. 2. Do not lift anything that weighs more than 20 pounds. 3. Inform client there may be pain not relieved with pain medication. 4. Stress the importance of having daily bowel movements.

1 ***1. Redness or irritation of the incision indicates infection and should be reported immediately to the HCP.* 2. The client should not lift anything heavier than five (5) pounds because it may cause dehiscence or evisceration of the bowel. 3. The pain medication should keep the client comfortable; if it doesn't, the client should call the HCP. 4. Some clients do not have daily bowel movements, but the nurse should instruct the client not to allow himself or herself to become constipated, which will increase pressure on the incision.

The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands teaching concerning the DASH diet? 1. "I should eat at least four (4) to five (5) servings of vegetables a day." 2. "I should eat meat that has a lot of white streaks in it." 3. "I should drink no more than two (2) glasses of whole milk a day." 4. "I should decrease my grain intake to no more than twice a week."

1 ***1. The DASH diet has proved beneficial in lowering blood pressure. It recommends eating a diet high in vegetables and fruits.* 2. The DASH diet recommends two (2) or fewer servings of lean meats, which have very few white streaks; the white streaks indicate the meat is high in fat. 3. The DASH diet recommends two (2) to three (3) servings of nonfat or low-fat milk, not whole milk. 4. The DASH diet recommends seven (7) to eight (8) servings of grain a day.

Which client problem would be priority in a client diagnosed with arterial occlusive disease who is admitted to the hospital with a foot ulcer? 1. Impaired skin integrity. 2. Activity intolerance. 3. Ineffective health maintenance. 4. Risk for peripheral neuropathy.

1 ***1. The client has a foot ulcer; therefore, the protective lining of the body—the skin—has been impaired.* 2. This is an appropriate problem, but would not take priority over impaired skin integrity. 3. The client needs teaching, but it does not take priority over a physiological problem. 4. The client has peripheral neuropathy, not a risk for it; this is the primary pathological change in a client with arterial occlusive disease.

The nurse is assessing the client diagnosed with long-term arterial occlusive disease. Which assessment data support the diagnosis? 1. Hairless skin on the legs. 2. Brittle, flaky toenails. 3. Petechiae on the soles of feet. 4. Nonpitting ankle edema.

1 ***1. The decreased oxygen over time causes the loss of hair on the tops of the feet and ascending both legs.* 2. The toenails are usually thickened due to hypoxemia. 3. Petechiae are tiny purple or red spots that appear on the skin as a result of minute hemorrhages within the dermal layer;this does not occur with arterial occlusive disease. 4. There may be edema but it is usually pitting; nonpitting edema resolves with elevation, but not in clients with arterial occlusive disease.

The client diagnosed with a DVT is on a heparin (an anticoagulant) drip at 1,400 units per hour, and Coumadin (warfarin sodium; also an anticoagulant) 5 mg twice a day. Which intervention should the nurse implement first? 1. Check the PTT and PT/INR. 2. Check with the HCP to see which drug should be discontinued. 3. Administer both medications. 4. Discontinue the heparin because the client is receiving Coumadin.

1 ***1. The nurse should check the laboratory values pertaining to the medications before administering the medications.* 2. The client will be administered an oral medication while still receiving a heparin drip to allow time for the client to achieve a therapeutic level of the oral medication before discontinuing the heparin. The effects of oral medications take three (3) to five (5) days to become therapeutic. 3. The laboratory values should be noted before administering the medications. 4. The heparin will be continued for three (3) to five (5) days before being discontinued. TEST-TAKING HINT: Knowing the actions of each medication, as well as the laboratory tests that monitor the safe range of dosing, is important. Remember, assessment is first. Assess blood levels and then administer the medication.

Which medical treatment would be prescribed for the client with an AAA less than 3 cm? 1. Ultrasound every six (6) months. 2. Intravenous pyelogram yearly. 3. Assessment of abdominal girth monthly. 4. Repair of abdominal aortic aneurysm.

1 ***1. When the aneurysm is small (<5 to 6 cm), an abdominal sonogram will be done every six (6) months until the aneurysm reaches a size at which surgery to prevent rupture is of more benefit than possible complications of an abdominal aortic aneurysm repair.* 2. An intravenous pyelogram evaluates the kidney. 3. The abdomen will not distend as the AAA enlarges. 4.This AAA is too small to perform surgery to remove it.

The unlicensed assistive personnel (UAP) is caring for the client diagnosed with chronic venous insufficiency. Which action would warrant immediate intervention from the nurse? 1. Removing compression stockings before assisting the client to bed. 2. Taking the client's blood pressure manually after using the machine. 3. Assisting the client by opening the milk carton on the lunch tray. 4. Calculating the client's shift intake and output with a pen and paper.

1 **1. Research shows that removing the compression stockings while the client is in bed promotes perfusion of the subcutaneous tissue. The foot of the bed should be elevated.* 2. The UAP can take the blood pressure with a machine or manually; therefore, the nurse would not need to intervene. 3. The UAP can help the client with meals as long as the client is stable. 4. The UAP can calculate the intake and output, but the nurse must evaluate the data to determine if they are normal for the client. TEST-TAKING HINT: This is a backward "except" question. Flipping the question and asking which actions would be appropriate for the UAP to implement might make it easier for the test taker to answer the question.

Which assessment data would support that the client has a venous stasis ulcer? 1. A superficial pink open area on the medial part of the ankle. 2. A deep pale open area over the top side of the foot. 3. A reddened blistered area on the heel of the foot. 4. A necrotic gangrenous area on the dorsal side of the foot.

1 **1. The medial part of the ankle usually ulcerates because of edema that leads to stasis, which, in turn, causes the skin to break down.* 2. A deep, pale, open area over the top side of the foot describes an arterial ulcer. 3. A reddened blistered area on the heel describes a blister that may result from wearing shoes that are too tight or that rub on the heel. 4. Gangrene does not usually occur with venous problems; it occurs with arterial ulcers. TEST-TAKING HINT: There are some questions that require the test taker to be knowledgeable of the disease process.

The client with varicose veins asks the nurse, "What caused me to have these?" Which statement by the nurse would be most appropriate? 1. "You have incompetent valves in your legs." 2. "Your legs have decreased oxygen to the muscle." 3. "There is an obstruction in the saphenous vein." 4. "Your blood is thick and can't circulate properly."

1 **1. Varicose veins are irregular, tortuous veins with incompetent valves that do not allow the venous blood to ascend the saphenous vein.* 2. Decreased oxygen to the muscle occurs with arterial occlusive disease. 3. This is the explanation for a deep vein thrombosis. 4. Thick, poorly circulating blood could be an explanation for diabetic neuropathy. TEST-TAKING HINT: Knowing that veins have valves and arteries do not might help the test taker select the correct answer. The test taker should use knowledge of anatomy and physiology to determine the answer.

Which client would be most at risk for developing varicose veins? 1. A Caucasian female who is a nurse. 2. An African American male who is a bus driver. 3. An Asian female with no children. 4. An elderly male with diabetes.

1 **1. Varicose veins are more common in white females in occupations that involve prolonged standing.* 2. Driving a bus does not require prolonged standing, which is a risk factor for developing varicose veins. 3. Studies suggest that the increased risk for varicose veins is common during pregnancy and may be the result of venous stasis. 4. Diabetes may lead to diabetic neuropathy and arterial occlusive disease, but it does not lead to varicose veins. TEST-TAKING HINT: The test taker must know that prolonged standing is a risk factor for varicose veins and identify which occupations include being on the feet most of the time.

The nurse is teaching the client recently diagnosed with essential hypertension. Which instruction should the nurse provide when discussing exercise? 1. Walk at least 30 minutes a day on flat surfaces. 2. Perform light weight lifting three (3) times a week. 3. Recommend high-level aerobics daily. 4. Encourage the client to swim laps once a week.

1 **1. Walking 30 to 45 minutes a day will help to reduce blood pressure, weight, and stress and will increase a feeling of overall well-being.* 2. Isometric exercises (such as weight lifting) should be discouraged because performing them can raise the systolic blood pressure. 3. The client should walk, cycle, jog, or swim daily, but high-level aerobic exercise may increase the client's blood pressure. 4. Swimming laps is recommended, but it should be daily, not once a week.

Which interventions should the nurse discuss with the client diagnosed with atherosclerosis? Select all that apply. 1. Include the significant other in the discussion. 2. Stop smoking or using any type of tobacco products. 3. Maintain a sedentary lifestyle as much as possible. 4. Avoid stressful situations. 5. Daily isometric exercises are important.

1, 2 ***1. Adherence to lifestyle modifications is enhanced when the client receives support from significant others.* ***2. Tobacco use is the most significant modifiable risk factor that contributes to the development of atherosclerosis.* 3. A sedentary lifestyle should be discouraged; daily walking or swimming is encouraged. 4. This is an unrealistic intervention. The nurse needs to help the client learn ways to deal with stressful situations, not avoid the situations. 5. Isometric exercises are weight-lifting exercises, which should be discouraged; isotonic exercises, such as walking or swimming, are encouraged.

The nurse is completing a neurovascular assessment on the client with chronic venous insufficiency. What should be included in this assessment? Select all that apply. 1. Assess for paresthesia. 2. Assess for pedal pulses. 3. Assess for paralysis. 4. Assess for pallor. 5. Assess for polar.

1, 2, 3, 4, 5 1. The nurse should determine if the client has any numbness or tingling. 2. The nurse should determine if the client has pulses, the presence of which indicates there is no circulatory compromise. 3. The nurse should determine if the client can move the feet and legs. 4. The nurse should determine if the client's feet are pink or pale. 5. The nurse should assess the feet to determine if they are cold or warm.

The client is diagnosed with a small abdominal aortic aneurysm. Which interventions should be included in the discharge teaching? Select all that apply. 1. Tell the client to exercise three (3) times a week for 30 minutes. 2. Encourage the client to eat a low-fat, low-cholesterol diet. 3. Instruct the client to decrease tobacco use. 4. Discuss the importance of losing weight with the client. 5. Teach the client to wear a truss at all times.

1, 2, 4 ***1. The most common cause of AAA is atherosclerosis, so teaching should address this area.* ***2. A low-fat, low-cholesterol diet will help decrease development of atherosclerosis.* 3. The client should not decrease tobacco use—he or she must quit totally. Smoking is the one modifiable risk factor that is not negotiable. ***4. Losing weight will help decrease the pressure on the AAA and will help address decreasing the cholesterol level.* 5. A truss is worn by a client with a hernia, not an AAA.

The nurse is teaching the client diagnosed with arterial occlusive disease. Which interventions should the nurse include in the teaching? Select all that apply. 1. Wash legs and feet daily in warm water. 2. Apply moisturizing cream to feet. 3. Buy shoes in the morning hours only. 4. Do not wear any type of knee stocking. 5. Wear clean white cotton socks.

1, 2, 4, 5 ***1. Cold water causes vasoconstriction and hot water may burn the client's feet; therefore, warm (tepid) water should be recommended.* ****2. Moisturizing prevents drying of the feet.* 3. Shoes should be purchased in the afternoon when the feet are the largest. ***4. This will further decrease circulation to the legs.* ***5. Colored socks have dye, and dirty socks may cause foot irritation that may lead to breaks in the skin.*

The intensive care department nurse is calculating the total intake for a client diagnosed with hypertensive crisis. The client has received 880 mL of D5W, IVPB of 100 mL of 0.9% NS, 8 ounces of water, 4 ounces of milk, and 6 ounces of chicken broth. The client has had a urinary output of 1,480 mL. What is the total intake for this client? _______

1,520 mL total intake. The urinary output is not used in this calculation. The nurse must add up both intravenous fluids and oral fluids to obtain the total intake for this client: 880 + 100 = 980 IV fluids Oral fluids (1 ounce = 30 mL): 8 ounces × 30 mL = 240 mL, 4 ounces × 30 mL = 120 mL, 6 ounces × 30 mL = 180 mL 240 + 120 + 180 = 540 mL oral fluids Total intake is 980 + 540 = 1,520 mL.

The HCP prescribes an HMG-CoA reductase inhibitor (statin) medication to a client with CAD. Which should the nurse teach the client about this medication? 1. Take this medication on an empty stomach. 2. This medication should be taken in the evening. 3. Do not be concerned if muscle pain occurs. 4. Check your cholesterol level daily.

2 1. A statin medication can be taken with food or on an empty stomach. ***2. Statin medications should be taken in the evening for best results because the enzyme that destroys cholesterol works best in the evening and the medication enhances this process.* 3. Cholesterol-reducing medications can cause serious liver problems, and if a client has muscle pain, it is an adverse effect that should be reported to the HCP. 4. The cholesterol level is checked every few months, not on a daily basis.

The client tells the nurse that his cholesterol level is 240 mg/dL. Which action should the nurse implement? 1. Praise the client for having a normal cholesterol level. 2. Explain that the client needs to lower the cholesterol level. 3. Discuss dietary changes that could help increase the level. 4. Allow the client to ventilate feelings about the blood test result.

2 1. The cholesterol level should be less than 200 mg/dL. ***2. The client needs to be taught ways to lower the cholesterol level.* 3. The client should be taught a low-fat, low-cholesterol diet to help lower the cholesterol level. 4. The nurse needs to discuss facts concerning the cholesterol level and teach the client. A therapeutic conversation would not be appropriate.

The client with varicose veins is six (6) hours postoperative vein ligation. Which nursing intervention should the nurse implement first? 1. Assist the client to dangle the legs off the side of the bed. 2. Assess and maintain pressure bandages on the affected leg. 3. Apply a sequential compression device to the affected leg. 4. Administer the prescribed prophylactic intravenous antibiotic.

2 1. Because the saphenous vein is removed during vein ligation, standing and sitting are prohibited during the initial recovery period to prevent increased pressure in the lower extremities. **2. Pressure bandages are applied for up to six (6) weeks after vein ligation to help prevent bleeding and to help venous return from the lower extremities when in the standing or sitting position.* 3. Sequential compression devices are used to help prevent deep vein thrombosis. 4. Antibiotics would be ordered prophylactically for surgery, but it is not the first intervention. TEST-TAKING HINT: When the question asks the test taker to implement the first intervention, two or more of the answer options could be possible interventions, but only one is implemented first. Apply the nursing process and select the intervention that addresses assessment, which is the first part of the nursing process.

Which actions should the surgical scrub nurse take to prevent personally developing a DVT? 1. Keep the legs in a dependent position and stand as still as possible. 2. Flex the leg muscles and change the leg positions frequently. 3. Wear white socks and shoes that have a wedge heel. 4. Ask the surgeon to allow the nurse to take a break midway through each surgery.

2 1. Keeping the legs dependent and standing still will promote the development of a DVT. ***2. Flexing the leg muscles and changing positions assist the blood to return to the heart and move out of the peripheral vessels.* 3. The nurse should wear support stockings, not socks, and change the types of shoes worn from day to day, varying the type of heels. 4. This is not in the client's best interest. TEST-TAKING HINT: The test taker can eliminate option "4" by imagining the reaction of the HCP if this were done. The words "dependent" and "still" make option "1" wrong.

The client diagnosed with essential hypertension is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse? 1. The telemetry reads normal sinus rhythm. 2. The client has a weight gain of 2 kg within 1 to 2 days. 3. The client's blood pressure is 148/92. 4. The client's serum potassium level is 4.5 mEq.

2 1. Normal sinus rhythm indicates that the client's heart is working normally. ***2. Rapid weight gain—for example, 2 kg in one (1) to two (2) days—indicates that the loop diuretic is not working effectively; 2 kg equals 4.4 lbs; 1 L of fluid weighs l kg.* 3. This blood pressure is not life-threateningly high and does not require immediate intervention. 4. Loop diuretics cause an increase in potassium excretion in the urine; therefore, the potassium level should be assessed, but 4.5 mEq/L is within normal limits (3.5 to 5.5 mEq/L).

The nurse is discharging a client diagnosed with DVT from the hospital. Which discharge instructions should be provided to the client? 1. Have the PTT levels checked weekly until therapeutic range is achieved. 2. Staying at home is best, but if traveling, airplanes are better than automobiles. 3. Avoid green leafy vegetables and notify the HCP of red or brown urine. 4. Wear knee stockings with an elastic band around the top.

2 1. Organs in the right upper quadrant include the liver and gallbladder. ***2. The aorta traverses the abdomen in the midline position, and that is the best location to hear an abdominal bruit. The bell should be placed mid- line above the umbilicus to best auscultate an abdominal bruit.* 3. Organs in the left upper quadrant include the stomach, pancreas, and spleen. 4. Organs in the left lower quadrant are the colon and ovaries in females.

The client comes to the clinic complaining of muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client's record? 1. Peripheral vascular disease. 2. Intermittent claudication. 3. Deep vein thrombosis. 4. Dependent rubor.

2 1. Peripheral vascular disease is a broad term that encompasses both venous and arterial peripheral problems of the lower extremities. ***2. This is the classic symptom of arterial occlusive disease.* 3. This is characterized by calf tenderness, calf edema, and a positive Homans' sign. 4. This term is a sign of arterial occlusive disease; the legs are pale when elevated but are dark red when in the dependent position.

The nurse is teaching a class on arterial essential hypertension. Which modifiable risk factors would the nurse include when preparing this presentation? 1. Include information on retinopathy and nephropathy. 2. Discuss sedentary lifestyle and smoking cessation. 3. Include discussions on family history and gender. 4. Provide information on a low-fiber and high-salt diet.

2 1. Retinopathy and nephropathy are compli- cations of uncontrolled hypertension, not modifiable risk factors. ***2. Sedentary lifestyle is discouraged in clients with hypertension; daily isotonic exercises are recommended. Smoking (cigars have problems too) increases the atherosclerotic process in vessels; causes vasoconstriction of vessels; and adheres to hemoglobin, decreasing oxygen levels.* 3. Family history and gender are nonmodifiable risk factors. The question is asking for information on modifiable risk factors. 4. A low-salt diet is recommended because increased salt intake causes water retention, which increases the workload of the heart. A high-fiber diet is recommended because it helps decrease cholesterol levels.

Which assessment data would the nurse recognize to support the diagnosis of abdominal aortic aneurysm (AAA)? 1. Shortness of breath. 2. Abdominal bruit. 3. Ripping abdominal pain. 4. Decreased urinary output.

2 1. Shortness of breath indicates a respiratory problem or possible a thoracic aneurysm, not an AAA. ***2. A systolic bruit over the abdomen is a diagnostic indication of an AAA.* 3. Ripping or tearing pain indicates a dissecting aneurysm. 4. Urine output is not diagnostic of an AAA.

The nurse is caring for clients on a telemetry floor. Which nursing task would be most appropriate to delegate to an unlicensed assistive personnel (UAP)? 1. Teach the client how to perform a glucometer check. 2. Assist feeding the client diagnosed with congestive heart failure. 3. Check the cholesterol level for the client diagnosed with atherosclerosis. 4. Assist the nurse to check the unit of blood at the client's bedside.

2 1. Teaching cannot be delegated to a UAP. ***2. The UAP can feed a client.* 3. The UAP cannot assess the client and does not have the education to interpret laboratory data. 4. A unit of blood must be checked by two (2) registered nurses at the bedside.

Which health-care provider's order should the nurse question in a client diagnosed with an expanding abdominal aortic aneurysm who is scheduled for surgery in the morning? 1. Type and crossmatch for two (2) units of blood. 2. Tap water enema until clear fecal return. 3. Bedrest with bathroom privileges. 4. Keep NPO after midnight.

2 1. The client is at risk for bleeding; therefore, this order would not be questioned. ***2. Increased pressure in the abdomen secondary to a tap water enema could cause the AAA to rupture.* 3. The client should be able to ambulate to the bathroom without any problems. 4. Clients are NPO prior to surgery to help prevent aspiration or problems from general anesthesia.

The nurse is caring for the client with chronic venous insufficiency. Which statement indicates the client understands the discharge teaching? 1. "I shouldn't cross my legs for more than 15 minutes." 2. "I need to elevate the foot of my bed while sleeping." 3. "I should take a baby aspirin every day with food." 4. "I should increase my fluid intake to 3,000 mL a day."

2 1. The client should not cross the legs at all because this further impedes the blood from ascending the saphenous vein. **2. Elevating the foot of the bed while sleeping helps the venous blood return to the heart and decreases pressure in the lower extremity.* 3. Antiplatelet therapy is for arterial blood, not venous blood. 4. Fluid intake will not help prevent or improve chronic venous insufficiency. TEST-TAKING HINT: Knowing about the venous and arterial blood systems will help the test taker eliminate or identify the correct answer. Venous blood goes back to the heart, so elevating the feet will help return it. Options "3" and "4" do not have anything to do with the extremities.

The client is one (1) day postoperative abdominal aortic aneurysm repair. Which information from the unlicensed assistive personnel (UAP) would require immediate intervention from the nurse? 1. The client refuses to turn from the back to the side. 2. The client's urinary output is 90 mL in six (6) hours. 3. The client wants to sit on the side of the bed. 4. The client's vital signs are T 98, P 90, R 18, and BP 130/70.

2 1. The nurse needs to intervene, but it does not require immediate intervention. ***2. The client must have 30 mL of urinary output every hour. Clients who are post-AAA are at high risk for renal failure because of the anatomical location of the AAA near the renal arteries.* 3. The client can sit on the bed the first day postoperation; this is, in fact, encouraged. 4. These vital signs would not warrant immediate intervention by the nurse.

The 80-year-old client is being discharged home after having surgery to débride a chronic venous ulcer on the right ankle. Which referral would be most appropriate for the client? 1. Occupational therapist. 2. Social worker. 3. Physical therapist. 4. Cardiac rehabilitation.

2 1. The occupational therapist assists the client with activities of daily living skills, such as eating, bathing, or brushing teeth. **2. The social worker would assess the client to determine if home health care services or financial interventions were appropriate for the client. The client is elderly, immobility is a concern, and wound care must be a concern when the client is discharged home.* 3. The physical therapist addresses gait training and transferring. 4. Cardiac rehabilitation helps clients who have had myocardial infarctions, cardiac bypass surgery, or congestive heart failure recover. TEST-TAKING HINT: The test taker must be aware of the responsibilities of other members of the health-care team. "Discharge" is the key word in the stem. The test taker should select an answer that will help the client in the home.

The wife of a client with arterial occlusive disease tells the nurse, "My husband says he is having rest pain. What does that mean?" Which statement by the nurse would be most appropriate? 1. "It describes the type of pain he has when he stops walking." 2. "His legs are deprived of oxygen during periods of inactivity." 3. "You are concerned that your husband is having rest pain." 4. "This term is used to support that his condition is getting better."

2 1. The pain stops when the client quits walking; therefore, it is not rest pain. ***2. Rest pain indicates a worsening of the arterial occlusive disease; the muscles of the legs are not getting enough oxygen when the client is resting to prevent muscle ischemia.* 3. This is a therapeutic response and does not answer the wife's question. 4. Rest pain indicates that the arterial occlusive disease is getting worse.

The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which intervention should the nurse implement? 1. Notify the health-care provider if the potassium level is 3.8 mEq. 2. Question administering the medication if the BP is <90/60 mm Hg. 3. Do not administer the medication if the client's radial pulse is >100. 4. Monitor the client's BP while he or she is lying, standing, and sitting.

2 1. The potassium level is within normal limits (3.5 to 5.5 mEq/L), and it is not usually checked prior to administering beta blockers. ***2. The nurse should question administering the beta blocker if the BP is low because this medication will cause the blood pressure to drop even lower, leading to hypotension.* 3. The nurse would not administer the medication if the apical (not radial) pulse were less than 60 beats per minute. 4. The nurse needs to assess the blood pressure only once prior to administering the medication (not take all three blood pressures prior to administering the medication).

The 66-year-old male client has his blood pressure (BP) checked at a health fair. The BP is 168/98. Which action should the nurse implement first? 1. Recommend that the client have his blood pressure checked in one (1) month. 2. Instruct the client to see his health-care provider as soon as possible. 3. Discuss the importance of eating a low-salt, low-fat, low-cholesterol diet. 4. Explain that this BP is within the normal range for an elderly person.

2 1. This BP is elevated, and the client should have his BP checked frequently but not before seeking medical treatment. **2. The diastolic blood pressure should be less than 85 mm Hg according to the American Heart Association; therefore, this client should see the health-care provider.* 3. Teaching is important, but the nurse must first make sure the client sees the health- care provider for a thorough checkup and antihypertensive medication prescription. Diet alone should not be recommended by the nurse. 4. This is not the normal range for an elderly person's blood pressure; the diastolic should be less than 85 mm Hg.

The nurse just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with coronary artery disease who has a BP of 170/100. 2. The client diagnosed with deep vein thrombosis who is complaining of chest pain. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 98%. 4. The client diagnosed with ulcerative colitis who has non bloody diarrhea.

2 1. This blood pressure is elevated, but it is not life threatening. ***2. The chest pain could be a pulmonary embolus secondary to deep vein thrombosis and requires immediate intervention by the nurse.* 3. A pulse oximeter reading of greater than 93% is within normal limits. 4. Nonbloody diarrhea is an expected sign of ulcerative colitis and would not require immediate intervention by the nurse.

The client diagnosed with a DVT is placed on a medical unit. Which nursing interventions should be implemented? Select all that apply. 1. Place sequential compression devices on both legs. 2. Instruct the client to stay in bed and not ambulate. 3. Encourage fluids and a diet high in roughage. 4. Monitor IV site every 4 hours and PRN. 5. Assess Homans' sign every 24 hours.

2 1. This protects the client's privacy. ***2. The UAP could dislodge a blood clot in the leg when massaging the calf. The UAP can apply lotion gently, being sure not to massage the leg.* 3. Testing the temperature of the water prevents scalding the client with water that is too hot or making the client uncomfortable with water that is too cold. 4. Collecting supplies needed before beginning the bath is using time wisely and avoids interrupting the bath to go and get items needed. TEST-TAKING HINT: This is an "except" question, so all options except one (1) will be actions that should be encouraged. The test taker should not jump to the first option and choose it as the correct answer.

The client is diagnosed with an abdominal aortic aneurysm. Which statement would the nurse expect the client to make during the admission assessment? 1. "I have stomach pain every time I eat a big, heavy meal." 2. "I don't have any abdominal pain or any type of problems." 3. "I have periodic episodes of constipation and then diarrhea." 4. "I belch a lot, especially when I lay down after eating."

2 1. This statement would not make the nurse suspect an AAA. ***2. Only about two-fifths of clients with AAA have symptoms; the remainder are asymptomatic.* 3. Periodic episodes of constipation and diarrhea may indicate colon cancer but do not support a diagnosis of AAA. 4. Belching does not support a diagnosis of AAA, but it could possibly indicate gastroesophageal reflux or a hiatal hernia.

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2, 3, 4 1. Sequential compression devices provide gentle compression of the legs to prevent DVT, but they are not used to treat DVT because the compressions could cause the clot to break loose. ***2. Clients should be on bedrest for five (5) to seven (7) days after diagnosis to allow time for the clot to adhere to the vein wall, thereby preventing embolization.* ***3. Bedrest and limited activity predispose the client to constipation. Fluids and diets high in fiber will help prevent constipation. Fluids will also help provide adequate fluid volume in the vasculature.* ***4. The client will be administered a heparin IV drip, which should be monitored.* 5. Homans' sign is assessed to determine if a DVT is present. This client has already been diagnosed with a DVT. Manipulating the leg to determine the presence of Homans' sign could dislodge the clot. TEST-TAKING HINT: Two (2) of the answer options are used to determine if a DVT is present or to prevent one. The test taker should not become confused about treatment and prevention or early diagnosis.

Which assessment data would cause the nurse to suspect the client has atherosclerosis? 1. Change in bowel movements. 2. Complaints of a headache. 3. Intermittent claudication. 4. Venous stasis ulcers.

3 1. A change in bowel movements may indicate cancer but not atherosclerosis. 2. A headache is not a sign/symptom of atherosclerosis. ***3. Intermittent claudication is a sign of generalized atherosclerosis and is a marker of atherosclerosis.* 4. Atherosclerosis indicates arterial involvement, not venous involvement.

Which client would be most likely to develop an abdominal aortic aneurysm? 1. A 45-year-old female with a history of osteoporosis. 2. An 80-year-old female with congestive heart failure. 3. A 69-year-old male with peripheral vascular disease. 4. A 30-year-old male with a genetic predisposition to AAA.

3 1. AAAs affect men four (4) times more often than women. 2. AAAs affect men four (4) times more often than women. ***3. The most common cause of AAA is atherosclerosis (which is the cause of peripheral vascular disease); it occurs in men four (4) times more often than women and primarily in Caucasians.* 4. AAAs occur most often in elderly men, and there is no genetic predisposition.

Which medication should the nurse expect the health-care provider to order for a client diagnosed with arterial occlusive disease? 1. An anticoagulant medication. 2. An antihypertensive medication. 3. An antiplatelet medication. 4. A muscle relaxant.

3 1. An anticoagulant medication is prescribed for venous problems, such as deep vein thrombosis. 2. Arterial occlusive disease is caused by atherosclerosis, which may cause hypertension as well, but antihypertensive medications are not prescribed for arterial occlusive disease. ***3. Antiplatelet medications, such as aspirin or clopidogrel (Plavix), inhibit platelet aggregations in the arterial blood.* 4. A muscle relaxant will not help the leg pain since the origin of the pain is decreased oxygen to the muscle

The client is being admitted with Coumadin (warfarin, an anticoagulant) toxicity. Which laboratory data should the nurse monitor? 1. Blood urea nitrogen (BUN) levels. 2. Bilirubin levels. 3. International normalized ratio (INR). 4. Partial thromboplastin time (PTT).

3 1. BUN laboratory tests are measurements of renal functioning. 2. Bilirubin is a liver function test. ***3. PT/INR is a test to monitor warfarin (Coumadin) action in the body.* 4. PTT levels monitor heparin activity. TEST-TAKING HINT: The test taker should devise some sort of memory-jogging mnemonic or aid to remember which laboratory test monitors for which condition. Try "PT boats go to war," so PT monitors warfarin.

The health-care provider prescribes an ACE inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for administering this medication? 1. ACE inhibitors prevent beta receptor stimulation in the heart. 2. This medication blocks the alpha receptors in the vascular smooth muscle. 3. ACE inhibitors prevent vasoconstriction and sodium and water retention. 4. ACE inhibitors decrease blood pressure by relaxing vascular smooth muscle.

3 1. Beta-adrenergic blocking agents, not ACE inhibitors, prevent the beta receptor stimulation in the heart, which decreases heart rate and cardiac output. 2. Alpha-adrenergic blockers, not ACE inhibitors, block alpha receptors in the vascular smooth muscle, which decreases vasomotor tone and vasoconstriction. **3. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II, and this, in turn, prevents vasoconstriction and sodium and water retention.* 4. Vasodilators, not ACE inhibitors, reduce blood pressure by relaxing vascular smooth muscle, especially in the arterioles.

Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease? 1. Encourage the client to use a heating pad on the lower extremities. 2. Demonstrate to the client the correct way to apply elastic support hose. 3. Instruct the client to walk daily for at least 30 minutes. 4. Tell the client to check both feet for red areas at least once a week.

3 1. External heating devices are avoided to reduce the risk of burns. 2. Elastic support hose reduce the circulation to the skin and are avoided. ***3. Walking promotes the development of collateral circulation to ischemic tissue and slows the process of atherosclerosis.* 4. The feet must be checked daily, not weekly.

The nurse knows the client understands the teaching concerning a low-fat, low- cholesterol diet when the client selects which meal? 1. Fried fish, garlic mashed potatoes, and iced tea. 2. Ham and cheese on white bread and whole milk. 3. Baked chicken, baked potato, and skim milk. 4. A hamburger, French fries, and carbonated beverage.

3 1. Fried foods are high in fat and cholesterol. 2. White bread is not high in fiber; wheat bread should be recommended because it is high in fiber. Whole milk is high in fat; skim milk should be used. ***3. Baked, broiled, or grilled meats are recommended; a plain baked potato is appropriate; and skim milk is low in fat—so this meal is appropriate for a low-fat, low-cholesterol diet.* 4. Hamburger meat is high in fat, French fries are usually cooked in oil (which is high in fat), and carbonated beverages are high in calories.

The nurse is teaching a class on atherosclerosis. Which statement describes the scientific rationale as to why diabetes is a risk factor for developing atherosclerosis? 1. Glucose combines with carbon monoxide, instead of with oxygen, and this leads to oxygen deprivation of tissues. 2. Diabetes stimulates the sympathetic nervous system, resulting in peripheral constriction that increases the development of atherosclerosis. 3. Diabetes speeds the atherosclerotic process by thickening the basement membrane of both large and small vessels. 4. The increased glucose combines with the hemoglobin, which causes deposits of plaque in the lining of the vessels.

3 1. Glucose does not combine with carbon monoxide. 2. Vasoconstriction is not a risk factor for developing atherosclerosis. ***3. This is the scientific rationale for why diabetes mellitus is a modifiable risk factor for atherosclerosis.* 4. When glucose combines with the hemoglobin in a laboratory test called glycosylated hemoglobin, the result can determine the client's average glucose level over the past three (3) months.

The client diagnosed with essential hypertension asks the nurse, "Why do I have high blood pressure?" Which response by the nurse would be most appropriate? 1. "You probably have some type of kidney disease that causes the high BP." 2. "More than likely you have had a diet high in salt, fat, and cholesterol." 3. "There is no specific cause for hypertension, but there are many known risk factors." 4. "You are concerned that you have high blood pressure. Let's sit down and talk."

3 1. Kidney disease leads to secondary hypertension; secondary hypertension is elevated blood pressure resulting from an identifi- able underlying process. 2. A high-salt, high-fat, high-cholesterol diet is a risk factor for essential hypertension,but it is not the only cause; therefore, this would be an incorrect answer. ***3. There is no known cause for essential hypertension, but many factors—both modifiable (obesity, smoking, diet) and nonmodifiable (family history, age, gender)—are risk factors for essential hypertension.* 4. This is a therapeutic reply that is inappropriate because the client needs facts.

The nurse is caring for clients on a surgical floor. Which client should be assessed first? 1. The client who is four (4) days postoperative abdominal surgery and is complain- ing of left calf pain when ambulating. 2. The client who is one (1) day postoperative hernia repair who has just been able to void 550 mL of clear amber urine. 3. The client who is five (5) days postoperative open cholecystectomy who has a T-tube and is being discharged. 4. The client who is 16 hours post-abdominal hysterectomy and is complaining of abdominal pain and is expelling flatus.

3 1. The client will be taking an oral anticoagulant, warfarin (Coumadin). Prothrombin time (PT) and international normalized ratio (INR) levels, not partial thromboplastin time (PTT), are monitored when this medication is taken. The client should be in therapeutic range before discharge. The HCP will determine how often to monitor the levels, usually in two (2) to three (3) weeks and then at three (3)- to six (6)-month intervals. 2. The client is not restricted to the home. The client should not take part in any activity that does not allow frequent active and passive leg exercises. In an airplane, the client should be instructed to drink plenty of fluids, move the legs up and down, and flex the muscles. If in an automobile, the client should stop to take frequent breaks to walk around. ***3. Green leafy vegetables contain vitamin K, which is the antidote for warfarin. These foods will interfere with the action of warfarin. Red or brown urine may indicate bleeding.* 4. The client should be instructed to wear stockings that do not constrict any area of the leg. TEST-TAKING HINT: The test taker must know laboratory data for specific medications. The INR and PT are monitored for oral anticoagulants. Remember: "PT boats go to war" (warfarin). PTT monitors heparin ("tt" is like an H for heparin).

The nurse has just received the a.m. shift report. Which client would the nurse assess first? 1. The client with a venous stasis ulcer who is complaining of pain. 2. The client with varicose veins who has dull aching muscle cramps. 3. The client with arterial occlusive disease who cannot move the foot. 4. The client with deep vein thrombosis who has a positive Homans' sign.

3 1. The client with a venous stasis ulcer should have pain, so this would be expected. 2. Dull, aching muscle cramps are expected with varicose veins. **3. The inability to move the foot means that a severe neurovascular compromise has occurred, and the nurse should assess this client first.* 4. A positive Homans' sign is expected in a client diagnosed with deep vein thrombosis.

The home health nurse is admitting a client diagnosed with a DVT. Which action by the client warrants immediate intervention by the nurse? 1. The client takes a stool softener every day at dinnertime. 2. The client is wearing a Medic Alert bracelet. 3. The client takes vitamin E over-the-counter medication. 4. The client has purchased a new recliner that will elevate the legs.

3 1. There is nothing that contraindicates the use of a stool softener, and use of one may be recommended if the client is prone to constipation and hard stool that could cause some bleeding from hemorrhoids. 2. A Medic Alert bracelet notifies any emergency HCP of the client's condition and medications. ***3. Vitamin E can affect the action of warfarin. The nurse should explain to the client that these and other medications could potentiate the action of warfarin.* 4. This would be recommended for the client if the footrest does not restrict blood flow in the calves. TEST-TAKING HINT: The test taker can eliminate option "1" by realizing that a stool softener would not cause a problem and could help with an unrelated problem. Medic Alert bracelets are frequently recommended for many clients with certain diseases and conditions.

Which assessment data would warrant immediate intervention in the client diagnosed with arterial occlusive disease? 1. The client has 2+ pedal pulses. 2. The client is able to move the toes. 3. The client has numbness and tingling. 4. The client's feet are red when standing.

3 1. These are normal pedal pulses and would not require any intervention. 2. Moving the toes is a good sign in a client with arterial occlusive disease. ***3. Numbness and tingling are paresthesia, which is a sign of a severely decreased blood supply to the lower extremities.* 4. Reddened extremities are expected secondary to increased blood supply when the legs are in the dependent position.

The client receiving low molecular weight heparin (LMWH) subcutaneously to prevent DVT following hip replacement surgery complains to the nurse that there are small purple hemorrhaged areas on the upper abdomen. Which action should the nurse implement? 1. Notify the HCP immediately. 2. Check the client's PTT level. 3. Explain this results from the medication. 4. Assess the client's vital signs.

3 1. This occurs from the administration of the low molecular weight heparin and is not a reason to notify the HCP. 2. A therapeutic range will not be achieved with LMWH, and PTT levels are usually not done. ***3. This is not hemorrhaging, and the client should be reassured that this is a side effect of the medication.* 4. Assessing the vital signs will not provide any pertinent information to help answer the client's question. TEST-TAKING HINT: Before selecting "Notify the HCP," the test taker should ask, "What will the HCP do with this information? What can the HCP order or do to help the purple hemorrhaged areas?" This would cause the test taker to eliminate option "1" as a possible answer.

The nurse is teaching a class on venous insufficiency. The nurse would identify which condition as the most serious complication of chronic venous insufficiency? 1. Arterial thrombosis. 2. Deep vein thrombosis. 3. Venous ulcerations. 4. Varicose veins.

3 1. Venous insufficiency is a venous problem, not an arterial problem. 2. Deep vein thrombosis is not a complication of chronic venous insufficiency, but it may be a cause. ***3. Venous ulcerations are the most serious complication of chronic venous insufficiency. It is very difficult for these ulcerations to heal, and often clients must be seen in wound care clinics for treatment.* 4. Varicose veins may lead to chronic venous insufficiency, but they are not a complication. TEST-TAKING HINT: The test taker must use knowledge of anatomy, which would eliminate option "1" because "venous" and "arterial" refer to different parts of the vascular system. The test taker must key in on the most serious complication to select the correct answer.

The nurse and an unlicensed assistive personnel (UAP) are caring for a 64-year-old client who is four (4) hours postoperative bilateral femoral-popliteal bypass surgery. Which nursing task should be delegated to the UAP? 1. Monitor the continuous passive motion machine. 2. Assist the client to the bedside commode. 3. Feed the client the evening meal. 4. Elevate the foot of the client's bed.

4 1. A continuous passive motion machine is used for a client with a total knee replacement, not for this type of surgery. 2. The client will be on bedrest at four hours after the surgery. Remember, the client had bilateral surgery on the legs. 3. There is nothing in the stem that would indicate the client could not feed himself or herself. The nurse should encourage independence as much as possible. ***4. After the surgery, the client's legs will be elevated to help decrease edema. The surgery has corrected the decreased blood supply to the lower legs.*

The client diagnosed with peripheral vascular disease is overweight, has smoked two (2) packs of cigarettes a day for 20 years, and sits behind a desk all day. What is the strongest factor in the development of atherosclerotic lesions? 1. Being overweight. 2. Sedentary lifestyle. 3. High-fat, high-cholesterol diet. 4. Smoking cigarettes.

4 1. Being overweight is not a risk factor for atherosclerotic lesions, but it does indicate that the client does not eat a healthy diet or exercise as needed. 2. Lack of exercise is a risk factor, but it is not the strongest. 3. Although the stem did not explicitly identify diet, the nurse should assume that a client who is obese would not eat a low-fat, low-cholesterol diet. ***4. Tobacco use is the strongest factor in the development of atherosclerotic lesions. Nicotine decreases blood flow to the extremities and increases heart rate and blood pressure. It also increases the risk of clot formation by increasing the aggregation of platelets.*

The client is employed in a job that requires extensive standing. Which intervention should the nurse include when discussing how to prevent varicose veins? 1. Wear low-heeled, comfortable shoes. 2. Wear clean white cotton socks. 3. Move the legs back and forth often. 4. Wear graduated compression hose.

4 1. Low-heeled, comfortable shoes should be recommended to help decrease foot pain, but they will not help prevent varicose veins. 2. Wearing clean white socks will help prevent irritation to the feet, but they will not help prevent varicose veins. 3. Moving the legs back and forth often may help prevent deep vein thrombosis, but it will not prevent varicose veins. **4. Graduated compression hose help decrease edema and increase the circulation back to the heart; this helps prevent varicose veins.* TEST-TAKING HINT: Options "1" and "2" could be eliminated as possible answers if the test taker knows that the varicose veins are in the leg, because options "1" and "2" are addressing the feet.

The nurse and an unlicensed assistive personnel (UAP) are bathing a bedfast client. Which action by the UAP warrants immediate intervention? 1. The UAP closes the door and cubicle curtain before undressing the client. 2. The UAP begins to massage and rub lotion into the client's calf. 3. The UAP tests the temperature of the water with the wrist before starting. 4. The UAP collects all the linens and supplies and brings them to the room.

4 1. Passive range-of-motion exercises are recommended to prevent contracture formation and muscle atrophy, but this is a musculoskeletal complication, not a cardiovascular one. 2. If the client is on a ventilator, then the paralysis associated with GB syndrome has moved up the spinal column to include the muscles of respiration. Passive range-ofmotion exercises are done by the staff; the client will not be able to do active ROM. 3. Range-of-motion exercises will not alleviate the pain of GB syndrome. 4. One reason for performing range-ofmotion exercises is to assist the blood vessels in the return of blood to the heart, preventing DVT. TEST-TAKING HINT: The question is asking for a cardiovascular reason for range-ofmotion exercises. Options "1," "2," and "3" do not have any cardiovascular component. Only option "4" discusses veins and blood.

Which assessment data would the nurse expect to find in the client diagnosed with chronic venous insufficiency? 1. Decreased pedal pulses. 2. Cool skin temperature. 3. Intermittent claudication. 4. Brown discolored skin.

4 1. Pedal pulses are normal in venous insufficiency, but pulses are decreased or absent in arterial insufficiency. 2. The skin is warm in venous insufficiency; the skin is cool in arterial insufficiency. 3. Intermittent claudication, pain that occurs when walking, is a symptom of arterial insufficiency. **4. Chronic venous insufficiency leads to chronic edema that, in turn, causes a brownish pigmentation to the skin.* TEST-TAKING HINT: The test taker could apply anatomical concepts to eliminate both options "1" and "2" because it is the arteries that have pulses and control the temperature of the skin.

The client asks the nurse, "My doctor just told me that atherosclerosis is why my legs hurt when I walk. What does that mean?" Which response by the nurse would be the best response? 1. "The muscle fibers and endothelial lining of your arteries have become thickened." 2. "The next time you see your HCP, ask what atherosclerosis means." 3. "The valves in the veins of your legs are incompetent so your legs hurt." 4. "You have a hardening of your arteries that decreases the oxygen to your legs."

4 1. The nurse should assume the client is a lay person and should not explain disease processes using medical terminology. 2. This is passing the buck; the nurse should have the knowledge to answer this question. 3. Atherosclerosis involves the arteries, not the veins. ***4. This response explains in plain terms why the client's legs hurt from atherosclerosis.*

The male client diagnosed with essential hypertension has been prescribed an alpha- adrenergic blocker. Which intervention should the nurse discuss with the client? 1. Eat at least one (1) banana a day to help increase the potassium level. 2. Explain that impotence is an expected side effect of the medication. 3. Take the medication on an empty stomach to increase absorption. 4. Change position slowly when going from lying to sitting position.

4 1. The potassium level is not affected by an alpha-adrenergic blocker. 2. Impotence is a major cause of noncompliance with taking prescribed medications forhypertension in male clients. The noncom- pliance should be reported to the HCP immediately so the medication can be changed. 3. The medication can be taken on an empty or a full stomach, depending on whether the client becomes nauseated after taking the medication. ***4. Orthostatic hypotension may occur when the blood pressure is decreasing and may lead to dizziness and light-headedness, so the client should change position slowly.*

The client diagnosed with arterial occlusive disease is one (1) day postoperative right femoral-popliteal bypass. Which intervention should the nurse implement? 1. Keep the right leg in the dependent position. 2. Apply sequential compression devices to lower extremities. 3. Monitor the client's pedal pulses every shift. 4. Assess the client's leg dressing every four (4) hours.

4 1. The right leg should be elevated to decrease edema, not flat or hanging off the side of the bed (dependent). 2. The left leg could have a sequential compression device to prevent deep vein thrombosis, but it should not be on the leg with an operative incision site. 3. The client is one (1) day postoperative, and the pedal pulses must be assessed more than once every eight (8) or 12 hours. ***4. The leg dressing needs to be assessed for hemorrhaging or signs of infection.*

The health-care provider ordered a femoral angiogram for the client diagnosed with arterial occlusive disease. Which intervention should the nurse implement? 1. Explain that this procedure will be done at the bedside. 2. Discuss with the client that he or she will be on bedrest with bathroom privileges. 3. Inform the client that no intravenous access will be needed. 4. Inform the client that fluids will be increased after the procedure.

4 1. This procedure will be done in a catheterization laboratory or special room, not at the bedside, because machines are used to visualize the extent of the arterial occlusion. 2. The client will have to keep the leg straight for at least six (6) hours after the procedure to prevent bleeding from the femoral artery. 3. An intravenous contrast medium is injected and vessels are visualized using fluoroscopy and x-rays. ***4. Fluids will help flush the contrast dye out of the body and help prevent kidney damage.*