Prep U-Chapter 30 Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation

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. Raynaud's disease b. Peripheral vascular disease c. Buerger's disease d. Arterial occlusive diseases

Raynaud's disease Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive

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) A history of diabetes mellitus b) Recent pelvic surgery c) An active daily walking program d) History of increased aspirin use

Recent pelvic surgery The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease

A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common? a) Renal failure b) Graft occlusion c) Hemorrhage and shock d) Enteric fistula

Renal failure Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys. Hemorrhage and shock are the most common complications before abdominal aortic aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair.

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? a) Decreasing blood pressure and increasing mobility b) Stabilizing heart rate and blood pressure and easing anxiety c) Increasing blood pressure and reducing mobility d) Increasing blood pressure and monitoring fluid intake and output

Stabilizing heart rate and blood pressure and easing anxiety For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

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) Stop smoking. b) Wear antiembolytic stockings daily to assist with blood return to the heart. c) Do not cross your legs for more than 30 minutes at a time. d) Keep your feet elevated above your heart.

Stop smoking. Nicotine from tobacco products causes vasospasm and can thereby dramatically reduce circulation to the extremities. When the client elevates the feet above the heart level, the heart must work against gravity to supply blood to the feet. Antiembolytic stocking are helpful for venous return to the heart, but constriction is not helpful for lack of arterial blood flow. Crossing the legs for more than a few minutes at a time compresses arteries and decreases blood supply to the legs and feet.

On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? a) Engaging in anaerobic exercise b) Taking daily walks c) Abstaining from foods that increase levels of high-density lipoproteins (HDLs) d) Reducing daily fat intake to less than 45% of total calories

Taking daily walks Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear. Anaerobic exercise may make these symptoms worse. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat, not abstain from, foods that raise HDL levels.

A pregnant client who developed deep vein thrombosis (DVT) in her right leg is receiving heparin I.V. on the medical floor. Physical therapy is ordered to maintain her mobility and prevent additional DVT. A nursing assistant working on the medical unit helps the client with bathing, range-of-motion exercises, and personal care. Which collaborative multidisciplinary considerations should the care plan address?

The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising. Feedback about possible bleeding and bruising from physical therapy and other caregivers should be incorporated into the care plan to ensure safety and optimal outcomes. Using a sequential compression device, mandating strict bed rest, and reporting signs of DVT don't incorporate collaborative care. Reporting signs of premature labor doesn't address the consequences of thrombocytopenia, which may occur with I.V. heparin therapy.

A nurse is changing a dressing on an arterial suture site. The site is red, with foul-smelling drainage. Based on these symptoms, the nurse is aware to monitor for which type of aneurysm?

Anastomotic An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma.

Following a percutaneous transluminal coronary angioplasty (PTCA), which of the following medications classifications would be used to prevent thrombus formation in the stent? a) Beta blockers b) Nitrates c) Antiplatelets d) Calcium channel blockers

Antiplatelets Because of the risk of thrombus formation following a coronary stent placement, the patient receives antiplatelet medications, such as Plavix or aspirin. Nitrates, beta blockers, and calcium channel blockers would not be used for this purpose.

The nurse is assessing a patient two days postoperatively who is suspected of having deep vein obstruction. The patient is complaining of pain in the left lower extremity and there is a 2-cm difference in the right and left leg circumference. What intervention can the nurse provide to promote arterial flow to the lower extremities?

Apply a heating pad to the patient's abdomen.

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? a) Neither venous nor arterial b) Trauma c) Arterial insufficiency d) Venous insufficiency

Arterial insufficiency Characteristics of arterial insuffiency ulcers include location at the tips of the toes, extreme painfulness, and circular shape with pale to black ulcer bases. Ulcers caused by venous insufficiency will be irregular in shape, minimal pain if superficial (can be painful), and usually located around the ankles or the anterier tibial area.

A patient complains about chest pain and heavy breathing when exercising or when stressed. Which of the following is a priority nursing intervention for the patient diagnosed with coronary artery disease? a) Assess the physical history of the patient b) Assess the blood pressure and administer aspirin c) Not important to assess the patient or to notify the physician d) Assess chest pain and administer prescribed drugs and oxygen

Assess chest pain and administer prescribed drugs and oxygen The nurse assesses the patient for chest pain and administers the prescribed drugs that dilate the coronary arteries. The nurse administers oxygen to improve the oxygen supply to the heart. Assessing the blood pressure or the physical history does not clearly indicate that the patient has CAD. The nurse does not administer aspirin without the physician's prescription.

The nurse is assessing a patient two days postoperatively who is suspected of having deep vein obstruction. The patient is complaining of pain in the left lower extremity and there is a 2-cm difference in the right and left leg circumference. What intervention can the nurse provide to promote arterial flow the the lower extremities? A. Administer a diuretic to decrease the edema in the left lower extremity. B. Assist with the active range-of-motion (ROM) exercises to the left lower extremity. C. Apply cool compresses to the left lower extremity. D. Apply a heating pad to the patient's abdomen.

Assist with the active range-of-motion (ROM) exercises to the left lower extremity.

You are presenting a workshop at the senior citizens center about how the changes of aging predispose clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a) Coronary thrombosis b) Arteriosclerosis c) Atherosclerosis d) Raynaud's disease

Atherosclerosis Atherosclerosis is the most common cause of peripheral arterial problems in the older adult. The disease correlates with the aging process. The other choices may occur at any age.

A patient 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) Ask about any skin color changes that occur in response to cold. b) Assess for unilateral swelling and tenderness of either leg. c) Attempt to palpate the dorsalis pedis and posterior tibial pulses. d) Check for the presence of tortuous veins bilaterally on the legs.

Attempt to palpate the dorsalis pedis and posterior tibial pulses. Intermittent claudication is a sign of peripheral arterial insufficiency. The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. A thorough assessment of the patient's skin color and temperature and the character of the peripheral pulses are important in the diagnosis of arterial disorders.

A client comes to the emergency department (ED) complaining of precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would you suspect in this client? a) Venous occlusive disease b) Cardiogenic shock c) Coronary artery disease d) Raynaud's disease

Coronary artery disease The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud's disease in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.

Which of the following are characteristics of arterial insufficiency? a) Diminished or absent pulses b) Pulses are present, may be difficult to palpate c) Aching, cramping pain d) Superficial ulcer

Diminished or absent pulses A diminished or absent pulse is a characteristic of arterial insufficiency. Venous characteristics include superficial ulcer formation, an aching and cramping pain, and presence of pulses

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. Superficial ulcer b. Diminished or absent pulses c. Aching, cramping pain d. Pulses that are present but difficult to palpate

Diminished or absent pulses Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency.

Which of the following aneurysms results in bleeding into the layers of the arterial wall? a) Anastomotic b) Dissecting c) False d) Saccular

Dissecting Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma. An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. (less)

The nurse knows which of the following diagnostic tests are used to document the anatomic site of reflux and provides a quantitative measure of the severity of valvular reflux? a) Duplex ultrasound scan b) Contrast phlebography c) Lymphoscintigraphy d) Lymphangiography

Duplex ultrasound scan Diagnostic tests for varicose veins include the duplex ultrasound scan, which documents the anatomic site of reflux and provides a quantitative measure of the severity of valvular reflux. Contrast phlebography involves injecting a radiopaque contrast agent into the venous system. Lymphoscintigraphy is done when a radioactively labeled colloid is injected subcutaneously in the second interdigital space. The extremity is then exercised to facilitate the uptake of the colloid by the lymphatic system, and serial images are obtained at present intervals. Lymphoangiography provides a way of detecting lymph node involvement resulting from metastatic carcinoma, lymphoma, or infection in sites that are otherwise inaccessible to the examiner except by surgery.

Which of the following statements is accurate regarding Reynaud's disease? a) It affects more than two digits on each hand or foot. b) Episodes may be triggered by unusual sensitivity to cold. c) The disease generally affects the patient bilaterally. d) It is most common in men 16 to 40 years of age.

Episodes may be triggered by unusual sensitivity to cold. Episodes of Reynaud's disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.

Which of the following is accurate regarding Raynaud's disease? a) It affects more than two digits on each hand or foot. b) It is generally bilateral. c) Episodes may be triggered by unusual sensitivity to cold. d) It is most common in men aged 16 to 40 years.

Episodes may be triggered by unusual sensitivity to cold. Episodes of Raynaud's disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between the ages of 16 and 40. It is generally unilateral and affects only one or two digits.

The nurse is reviewing the laboratory results for a patient diagnosed with coronary artery disease (CAD). The patient's low-density lipoprotein (LDL) level is 115 mg/dL. The nurse interprets this value as which of the following? a) Critically high b) Low c) Within normal limits d) High

High The normal LDL range is 100 mg/dL to 130 mg/dL. A level of 115 mg/dL is considered to be high. The goal of treatment is to decrease the LDL level below 100 mg/dL (less than 70 mg/dL for very high-risk patients).

A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? a. Rinne b. Phalen's c. Homans' d. Romberg's

Homans' A positive Homans' sign, or pain in the calf elicited upon flexion of the ankle with the leg straight, indicates the presence of a thrombus. Testing for Romberg's sign assesses cerebellar function. Phalen's test assesses carpal tunnel syndrome. The Rinne test compares air and bone conduction in both ears to screen for or confirm hearing loss.

When the postcardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the patient's serum electrolytes anticipating which abnormality? a) Hypercalcemia b) Hyponatremia c) Hyperkalemia d) Hypomagnesemia

Hyperkalemia Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Hypercalcemia would likely be demonstrated by asystole. Hypomagnesemia would likely be demonstrated by hypotension, lethargy, and vasodilation. Hyponatremia would likely be indicated by weakness, fatigue, and confusion without change in T wave formation.

Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery? a) Blood glucose level b) Activity intolerance c) Inadequate tissue perfusion d) Mental alertness

Inadequate tissue perfusion The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood sugar and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for patients undergoing cardiac surgery.

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? a) Elevated blood pressure and rapid respirations b) Decreased pulse rate and blood pressure c) Increased abdominal and back pain d) Retrosternal back pain radiating to the left arm

Increased abdominal and back pain Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? a) Excess fluid volume related to peripheral vascular disease b) Risk for injury related to edema c) Ineffective peripheral tissue perfusion related to venous congestion d) Impaired gas exchange related to increased blood flow

Ineffective peripheral tissue perfusion related to venous congestion Ineffective peripheral tissue perfusion related to venous congestion takes highest priority because venous inflammation and clot formation impede blood flow in a client with DVT. Impaired gas exchange related to increased blood flow is incorrect because impaired gas exchange is related to decreased, not increased, blood flow. Excess fluid volume related to peripheral vascular disease is inappropriate because there's no evidence that this client has an excess fluid volume. Risk for injury related to edema may be warranted but is secondary to ineffective tissue perfusion.

Which of the following terms refers to a muscular, cramplike pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest? a) Aneurysm b) Intermittent claudication c) Ischemia d) Bruit

Intermittent claudication Intermittent claudication is a sign of peripheral arterial insufficiency. An aneurysm is a localized sac of an artery wall formed at a weak point in the vessel. A bruit is the sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated vessel. Ischemia is a term used to denote deficient blood supply.

A nurse is teaching a patient newly diagnosed with arterial insufficiency. Which of the following terms should the nurse use to refer to leg pain that occurs when the patient is walking? a) Dyspnea b) Thromboangiitis obliterans c) Orthopnea d) Intermittent claudication

Intermittent claudication Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is the patient's subjective statement of difficulty breathing. Orthopnea is the inability of the patient to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Buerger's disease. (less)

Which of the following terms refers to leg pain that is brought on walking and caused by arterial insufficiency? a) Thromboangiitis obliterans b) Intermittent claudication c) Orthopnea d) Dyspnea

Intermittent claudication Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is the patient's subjective statement of difficulty breathing. Orthopnea is the inability of the patient to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Burger's disease.

Which term refers to enlarged, red, and tender lymph nodes?

Lymphadenitis Acute lymphadenitis is demonstrated by enlarged, red, and tender lymph nodes. Lymphangitis is acute inflammation of the lymphatic channels. Lymphedema is demonstrated by swelling of tissues in the extremities because of an increased quantity of lymph that results from an obstruction of lymphatic vessels. Elephantiasis refers to a condition in which chronic swelling of the extremity recedes only slightly with elevation.

A nurse is completing an assessment on a patient and discovers an enlarged, red, and tender lymph node. The nurse will describe and document the lymph node using which of the following terms? a) Lymphangitis b) Lymphedema c) Lymphadenitis d) Elephantiasis

Lymphadenitis Acute lymphadenitis is demonstrated by enlarged, red, and tender lymph nodes. Lymphangitis is an acute inflammation of the lymphatic channels. Lymphedema is demonstrated by swelling of tissues in the extremities because of an increased quantity of lymph that results from an obstruction of lymphatic vessels. Elephantiasis refers to a condition in which chronic swelling of the extremity recedes only slightly with elevation.

chronic venous occlusion, pulmonary embolism from dislodged thrombi, valvular destruction, and venous obstruction

Name four major complications of venous thrombosis.

A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment? a. Numbness, warm skin temperature, and redness b. Redness, cool skin temperature, and swelling c. Swelling, warm skin temperature, and drainage d. Numbness, cool skin temperature, and pallor

Numbness, cool skin temperature, and pallor Signs and symptoms of impaired circulation include numbness and cool, pale skin. Signs of localized infection may include swelling, drainage, redness, and warm skin. Signs of adequate circulation include normal sensation and warm skin with normal return of skin color after blanching.

Which of the following are risk factors for venous disorders of the lower extremities? a) Trauma b) Pacing wires c) Obesity d) Surgery

Obesity Careful assessment is invaluable in detecting early signs of venous disorders of the lower extremities. Patients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk. Other patients at high risk include those who are obese or older adults and women taking oral contraceptives.

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) Dipyridamole (Persantine) b) Epinephrine c) Oral N-acetylcysteine d) Oral iodine

Oral N-acetylcysteine Patients with impaired renal function scheduled for MDCT may require preprocedural treatment to prevent contrastinduced nephropathy. This may include oral or IV hydration 12 hours preprocedure; administration of oral N-acetylcysteine, which acts as an antioxidant; and/or administration of sodium bicarbonate, which alkalinizes urine and protects against free radical damage (Rundback, Nahl, & Yoo, 2011).

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. Keep the extremities elevated slightly. b. Participate in a regular walking program. c. Massage the calf muscles if pain occurs. d. Use a heating pad to promote warmth.

Participate in a regular walking program. Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and to resume activity when pain subsides. Extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. Heating pads should not be used by anyone with impaired circulation to avoid burns. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.

A nurse is caring for a client following an arterial vascular bypass graft in the leg. Over the next 24 hours, what should the nurse plan to assess? a) Blood pressure every 2 hours b) Color of the leg every 4 hours c) Peripheral pulses every 15 minutes following surgery d) Ankle-arm indices every 12 hours

Peripheral pulses every 15 minutes following surgery The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the patient's status remains stable. (less)

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? a) Decrease the heparin infusion rate. b) Start an I.V. infusion of dextrose 5% in water (D5W). c) Prepare to administer protamine sulfate. d) Monitor the partial thromboplastin time (PTT).

Prepare to administer protamine sulfate. Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.

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

Protamine sulfate Protamine sulfate is the antidote specific to heparin. Phytonadione (vitamin K) is the antidote specific to oral anticoagulants such as warfarin. (Heparin isn't given orally.) Thrombin is a hemostatic agent used to control local bleeding. Plasma protein fraction, a blood derivative, supplies colloids to the blood and expands plasma volume; it's used to treat clients who are in shock

The nurse completes discharge teaching for a patient following a femoral-to-popliteal bypass graft. What response by the patient would indicate teaching was effective? a) "It will important for me to sit at the kitchen table to promote better breathing." b) "I can now stop taking my Lipitor because my leg is fixed." c) "I can stop the exercises that were started in the hospital once I return home." d) "I will call if I develop any coldness, numbness, tingling, or pain in the surgical leg."

"I will call if I develop any coldness, numbness, tingling, or pain in the surgical leg." The nurse ensures that the patient has the knowledge and ability to assess for any postoperative complications such as infection, occlusion of the artery or graft, and decreased blood flow. Coldness, numbness, tingling, and pain are signs of peripheral arterial occlusion, and immediate intervention is required.

A community health nurse teaches a group of seniors about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which of the following statements? a) "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." b) "Since my family is from Italy, I have a higher risk of developing peripheral arterial disease." c) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." d) "The older I get the higher my risk for peripheral arterial disease gets."

"I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.

A client complains of leg pain brought on by walking several blocks — a symptom that first arose several weeks earlier. The client's history includes diabetes mellitus and a two-pack-per-day cigarette habit for the past 42 years. The physician diagnoses intermittent claudication and orders pentoxifylline (Trental), 400 mg three times daily with meals. Which instruction concerning long-term care should the nurse provide? a) "See the physician if complications occur." b) "Reduce your level of exercise." c) "Practice meticulous foot care." d) "Consider cutting down on your smoking."

"Practice meticulous foot care." Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing. Therefore, meticulous foot care is essential. The nurse should teach the client to bathe his feet in warm water and dry them thoroughly, cut the toenails straight across, wear well-fitting shoes, and avoid taking medications without the approval of a physician. Because nicotine is a vasoconstrictor, this client should stop smoking, not just consider cutting down. Daily walking is beneficial to clients with intermittent claudication. To evaluate the effectiveness of the therapeutic regimen, this client should see the physician regularly, not just when complications occur.

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) "Shoes made of synthetic material are best for my feet." b) "I should apply powder daily because my feet perspire." c) "I can use lamb's wool between my toes if necessary." d) "It is important to apply sunscreen to the top of my feet when wearing sandals."

"Shoes made of synthetic material are best for my feet." The client should wear leather shoes with an extra-depth toebox. Synthetic shoes do not allow air to circulate.

A patient admitted to the medical surgical unit with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are needed. Which response by the nurse is accurate? a) "Lovenox will dissolve the clot, and Coumadin will prevent any more clots from occurring." b) "Administration of two anticoagulants decreases the risk of recurrent venous thrombosis." c) "The Lovenox will work immediately, but the Coumadin takes several days to reach its full effect." d) "Because of the potential for a pulmonary embolism, it is important for you to have at least two anticoagulants."

"The Lovenox will work immediately, but the Coumadin takes several days to reach its full effect." Oral anticoagulants, such as warfarin, are monitored by the prothrombin time (PT) or the international normalized ratio (INR). Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (ie, when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0).

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) Prothrombin time (PT) b) Platelet count c) Partial thromboplastin time (PTT) d) Bleeding time

Prothrombin time (PT) PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample following addition of calcium ions and tissue thromboplastin and compares this time with the fibrin-clotting time in a control sample. The physician should adjust anticoagulant dosages as needed, to maintain PT at 1.5 to 2.5 times the control value. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reflects the number of circulating platelets in venous or arterial blood. PTT determines the effectiveness of heparin therapy and helps physicians evaluate bleeding tendencies. Physicians diagnose appoximately 99% of bleeding disorders on the basis of PT and PTT values.

Following abdominal surgery, which factor predisposes a client to deep vein thrombosis?

The client will be immobile during and shortly after surgery.

A client with venous insufficiency develops varicose veins in both legs. Which statement about varicose veins is accurate? a) The severity of discomfort isn't related to the size of varicosities. b) Sclerotherapy is used to cure varicose veins. c) Primary varicose veins are caused by deep vein thrombosis (DVT) and inflammation. d) Varicose veins are more common in men than in women.

The severity of discomfort isn't related to the size of varicosities. Clients with varicose veins commonly complain of aching, heaviness, itching, moderate swelling, and unsightly appearance of the legs. However, the severity of discomfort is hard to assess and seems unrelated to the size of varicosities. Varicose veins are more common in women than in men. Primary varicose veins typically result from a congenital or familial predisposition that makes the vein wall less elastic; secondary varicosities occur when trauma, obstruction, DVT, or inflammation damages valves. Sclerotherapy, in which a sclerosing agent is injected into a vein, is used to treat varicose veins; it doesn't cure them.

The nurse is assessing a hospital client who has low albumin levels due to liver disease. What assessment finding should the nurse attribute to the client's low albumin levels?

There is severe edema to the client's legs and abdomen. Albumin helps to keep fluids within the vascular space. Deficiencies, as a result, cause the release of fluid into interstitial spaces, causing edema. Hypoalbuminemia does not cause excessive bleeding, reduced energy or respiratory difficulties.

Which of the following is the most common site for a dissecting aneurysm? a. Lumbar area b. Thoracic area c. Sacral area d. Cervical area

Thoracic area The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients with thoracic aneurysms die of rupture of the aneurysm.

The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for? a) Ulceration b) Rudor c) Dermatitis d) Cellulitis

Ulceration Venous ulceration is the most serious complication of chronic venous insufficiency and can be associated with other conditions affecting the circulation of the lower extremities. Cellulitis or dermatitis may complicate the care of chronic venous insufficiency and venous ulcerations.

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 gater 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) Venous insufficiency b) Neither venous nor arterial insufficiency c) Trauma d) Arterial insufficiency

Venous insufficiency Symptoms of venous insufficiency include present pedal pulses, edema, pigmentation in gater area, and a reddish blue color. Ulcers caused by venous insufficiency will be irregular in shape and usually located around the ankles or the anterior tibial area. Characteristics of arterial insufficiency ulcers include location at the tips of the toes, great pain, and circular shape with a pale to black ulcer base.

rate= P/R

What is the most important factor in regulating the caliber of blood vessels, which determines resistance to flow?

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) loss of hair on the lower portion of the left leg. b) left calf circumference 1" (2.5 cm) larger than the right. c) pallor and coolness of the left foot. d) a decrease in the left pedal pulse.

left calf circumference 1" (2.5 cm) larger than the right. Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT.

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?

recent pelvic surg

What does the nurse understand is the most important factor in regulating the caliber of blood vessels, which determines resistance to flow? A. hormonal secretion B. independent arterial wall activity C. the influence of circulating chemicals D. the sympathetic nervous system

the sympathetic nervous system

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

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

A nurse suspects the presence of an abdominal aortic aneurysm. What assessment data would the nurse correlate with a diagnosis of abdominal aortic aneurysm? (Select all that apply) A. A pulsatile abdominal mass B. low back pain C. lower abdominal pain D. decreased bowel sounds E. diarrhea

-A pulsatile abdominal mass -low back pain -lower abdominal pain

The nurse is educating a patient with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply) A. Avoid constricting garments B. Elevate the legs above the heart level for 30 minutes every 2 hours C. Sit as much as possible to rest the valves in the legs. D. Sleep with the foot of the bed elevated about 6 inches E. Sit on the side of the bed and dangle the feet

-Avoid constricting garments -Elevate the legs above the heart level for 30 minutes every 2 hours -Sleep with the foot of the bed elevated about 6 inches

A patient is suspected to have a thoracic aortic aneurysm. What diagnostic test(s) does the nurse anticipate preparing the patient for? (Select all that apply.) A. computed tomography B. Transesophageal echocardiography C. x-ray D. electroencephalogram E. electrocardiogram (ECG)

-Computed tomography -Transesophageal echocardiography -X-ray Diagnosis of a thoracic aortic aneurysm is principally made by chest x-ray, computed tomography angiography (CTA), and transesophageal echocardiography (TEE).

The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) A. cool and cyanotic skin B. initial absence of edema C. sharp pain that may be relieved by the elevation of the extremity D. full superficial veins E. brisk capillary refill of the toes

-Cool and cyanotic skin -Sharp pain that may be relieved by the elevation of the extremity -Full superficial veins Postthrombotic syndrome is characterized by chronic venous stasis, resulting in edema, altered pigmentation, pain, and stasis dermatitis. The patient may notice the symptoms less in the morning and more in the evening. Obstruction or poor calf muscle pumping in addition to valvular reflux must be present for the development of severe postthrombotic syndrome and stasis ulcers. Superficial veins may be dilated.

The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse (Select all that apply). A. cool and cyanotic skin B. initial absence of edema C. sharp pain that may be relieved by the elevation of the extremity D. full superficial veins E. brisk capillary refill of the toes

-cool and cyanotic skin -sharp pain that may be relieved by the elevation of the extremity -full superficial veins

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. 0.10 B. 0.25 C. 0.35 D. 0.50

0.50 After the circulatory status has been assessed and determined to be adequate for healing (ABI of more than 0.5) (Mosti, Iabichella, & Partsch, 2012), surgical dressings can be used to promote a moist environment.

The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes a) a slowed heart rate. b) a vasospasm. c) diuresis. d) depression of the cough reflex.

A vasospasm. Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities. Nicotine has stimulant effects. Nicotine does not suppress cough. Smoking irritates the bronchial tree, causing coughing. Nicotine does not cause diuresis.

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) 4.5 times the baseline control. b) 1.5 to 2.5 times the baseline control. c) 3.5 times the baseline control. d) 2.5 to 3.0 times the baseline control.

1.5 to 2.5 times the baseline control. A normal PTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage.

Heparin therapy is usually considered therapeutic when the activated partial thromboplastin time (aPTT) is how many times higher than a normal value? 1 to 1.5 1.5 to 2 2 to 2.5 2.5 to 3

2 to 2.5

The nurse is monitoring a patient who is on heparin anticoagulant therapy. What should the nurse determine the therapeutic range of the international normalized ratio (INR) should be? 2.0-3.0 4.0-5.0 7.0-8.0 5.0-6.0

2.0-3.0

The nurse is monitoring a patient who is on heparin anticoagulant therapy. What should the nurse determine the therapeutic range of the international normalized ratio (INR) should be?

2.0-3.0 Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012).

When caring for a patient who has started anticoagulant therapy with warfarin (Coumadin), the nurse knows that therapeutic benefits will not occur for: a. The first 24 hours. b. 2 to 3 days. c. At least 12 hours. d. 3 to 5 days.

3 to 5 days. It takes 3 to 5 days for a therapeutic international normalized ratio (INR) to be achieved. Therefore, Coumadin is given concurrently with heparin until a therapeutic level is established, usually within 72 hours.

You are assessing a client recently admitted to your unit for hypotension. While assessing this client, you find a pulsatile mass near the umbilicus. What would you suspect? Coronary artery disease Aortic aneurysm Raynaud's disease Peripheral artery disease

Aortic aneurysm

Beginning warfarin concomitantly with heparin can provide a stable INR by which day of heparin treatment?

5 Beginning warfarin concomitantly with heparin can provide a stable INR by day 5 of heparin treatment, at which time the heparin maybe discontinued.

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

50

In a patient with a bypass graft, the distal outflow vessel must be at least what percentage patent for the graft to remain patent? a) 30 b) 20 c) 40 d) 50

50 The distal outflow vessel must be at least 50% patent for the graft to remain patent.

In order to be effective, percutaneous transluminal coronary angioplasty (PTCA) must be performed within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial infarction? a) 30 minutes b) 6 to 12 months c) 9 days d) 60 minutes

60 minutes The 60-minute interval is known as "door-to-balloon time" for performance of PTCA on a diagnosed MI patient. The 30-minute interval is known as "door-to-needle time" for administration of thrombolytics post MI. The time frame of 9 days refers to the time for onset of vasculitis after administration of streptokinase for thrombolysis in an acute MI patient. The 6 to 12 month time frame refers to the time period during which streptokinase will not be used again in the same patient for acute MI.

Which of the following diagnostic tests are used to quantify venous reflux and calf muscle pump ejection? a) Contrast phlebography b) Lymphangiography c) Lymphoscintigraphy d) Air plethysmography

Air plethysmography Air plethysmography is used to quantify venous reflux and calf muscle pump action. Contrast phlebography involves injecting a radiopaque contrast agent into the venous system. Lymphoscintigraphy is done when a radioactively labeled colloid is injected subcutaneously in the second interdigital space. The extremity is then exercised to facilitate the uptake of the colloid by the lymphatic system, and serial images are obtained at present intervals. Lymphoangiography provides a way of detecting lymph node involvement resulting from metastatic carcinoma, lymphoma, or infection in sites that are otherwise inaccessible to the examiner except by surgery.

Which of the following medications is considered a thrombolytic? a) Heparin b) Lovenox c) Coumadin d) Alteplase

Alteplase Alteplase is considered a thrombolytic, which lyses and dissolves thrombi. Thrombolytic therapy is most effective when given within the first 3 days after acute thrombosis. Heparin, Coumadin, and Lovenox do not lyse clots.

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: Urokinase. Reteplase. Streptokinase Alteplase.

Alteplase.

The nurse explains to a patient that the primary cause of a varicose vein is: a) Venous occlusion. b) Phlebothrombosis. c) An incompetent venous valve. d) Venospasm.

An incompetent venous valve. Varicose veins are abnormally dilated, tortuous, superficial veins caused by incompetent venous valves.

A nurse is changing a dressing on an arterial suture site. The site is red, with foul-smelling drainage. Based on these symptoms, the nurse is aware to monitor for which type of aneurysm?

Anastomotic

To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the: a) Anterior surface of the foot near the ankle joint. b) Inside of the ankle just above the heel. c) Outside of the foot just below the heel. d) Exterior surface of the foot near the heel.

Anterior surface of the foot near the ankle joint. The dorsalis pedis pulse can be palpated on the dorsal surface of the foot distal to the major prominence of the navicular bone. Refer to Figure 18-3 in the text.

A client in the ED has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining the client's history, which symptoms will it be most important for the nurse to ask about?

Hoarse voice and difficulty swallowing

Which of the following assessment results is considered a major risk factor for PAD? BP of 160/110 mm Hg Triglyceride level of 150 mg/dL LDL of 100 mg/dL Cholesterol of 200 mg/dL

BP of 160/110 mm Hg Hypertension is considered a major risk factor for PAD. Blood pressure should be less than 130/90 mm Hg. The other laboratory results are within the recommended range of normal to high normal.

A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection? a) Urine output of 150 ml/hour and heart rate of 45 beats/minute b) Urine output of 15 ml/hour and 2+ hematuria c) Blood pressure of 82/40 mm Hg and heart rate of 45 beats/minute d) Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute

Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute Assessment findings that indicate possible bleeding or recurring dissection include hypotension with reflex tachycardia (as evidenced by a blood pressure of 82/40 mm Hg and a heart rate of 125 beats/minute), decreased urine output, and unequal or absent peripheral pulses. Hematuria, increased urine output, and bradycardia aren't signs of bleeding from aneurysm repair or recurring dissection.

Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot? a) Air plethysmography b) Contrast phlebography c) Lymphoscintigraphy d) Lymphangiography

Contrast phlebography When a thrombus exists, an X-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.

The nurse is caring for a patient who returned from the tropics 2 weeks ago. The patient has been diagnosed with lymphangitis and is experiencing lymphedema. You are aware that the lymphedema may be due to what? a) Improper anticoagulant use b) Excessive lymph is the vascular space c) Sensitivity to antibiotics d) Obstructed lymph vessels

Obstructed lymph vessels

A client with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which is the most likely cause? a) The aneurysm has become obstructed. b) The aneurysm may be preparing to rupture. c) The client is experiencing normal sensations associated with this condition. d) The client is experiencing inflammation of the aneurysm.

The aneurysm may be preparing to rupture

hich of the following statements is accurate regarding Reynaud's disease?

Episodes may be triggered by unusual sensitivity to cold.

When assessing a client with cellulitis of the right leg, which finding should the nurse expect to observe? a) Painful skin that is swollen and pale in color b) Cold, red skin c) Red, swollen skin with inflammation spreading to surrounding tissues d) Small, localized blackened area of skin

Red, swollen skin with inflammation spreading to surrounding tissues Cellulitis, an inflammation of soft tissues, can extend to surrounding tissues. The skin becomes reddened, warm, swollen, and sometimes painful. The skin wouldn't be cold, pale, or necrotic.

A patient with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which of the following is the most likely cause? a) The patient is experiencing inflammation of the aneurysm. b) The aneurysm has become obstructed. c) The aneurysm may be preparing to rupture. d) The patient is experiencing normal sensations associated with this condition.

The aneurysm may be preparing to rupture. Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized in the middle or lower abdomen to the left of the midline. Low back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is rapidly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

Patients who are taking beta-adrenergic blocking agents should be cautioned not to stop taking their medications abruptly because which of the following may occur? a) Internal bleeding b) Worsening angina c) Thrombocytopenia d) Formation of blood clots

Worsening angina Patients taking beta blockers are cautioned not to stop taking them abruptly because angina may worsen and myocardial infarction may develop. Beta blockers do not cause the formation of blood clots, internal bleeding, or thrombocytopenia.

Which of the following is accurate regarding the effects of nicotine and tobacco smoke on the body? Select all that apply. a) Reduces circulation to the extremities b) Impairs transport and cellular use of oxygen c) Causes vasospasm d) Increases blood viscosity e) Decreases blood viscosity

a) Reduces circulation to the extremities b) Impairs transport and cellular use of oxygen c) Causes vasospasm d) Increases blood viscosity Nicotine from tobacco products causes vasospasm and can dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity.

The nurse is caring for a patient with peripheral arterial insufficiency. What can the nurse suggest to help relieve leg pain during rest? A. elevating the limb above heart level B. lowering the limb so that it is dependent C. massaging the limb after application of cold compresses D. placing the limb in a plane horizontal to the body

lowering the limb so that it is dependent

Which of the following are indications of a rupturing aortic aneurysm? Select all that apply. a) Constant, intense back pain b) Decreasing hematocrit c) Decreasing blood pressure d) Increasing hematocrit e) Increasing blood pressure

• Constant, intense back pain • Decreasing blood pressure • Decreasing hematocrit Indications of a rupturing abdominal aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

Which of the following are complications of percutaneous transluminal balloon angioplasty (PTA)? Select all that apply. a) Hematoma b) Embolization c) Bleeding d) Stent migration e) Dissection of the vessel

• Hematoma • Embolization • Dissection of the vessel • Bleeding • Stent migration Complications from PTA include hematoma, embolization dissection of the vessel, bleeding, intimal damage (dissection), and stent migration.

A nurse assesses a patient for a possible abdominal aortic aneurysm (AAA). Which of the following signs would the nurse recognize as positive indicators? Select all that apply. a) Low back pain b) An abdominal pulsatile mass c) Hypertension d) Lower abdominal pain e) Radiating chest pain f) A systolic bruit

• Low back pain • Lower abdominal pain • An abdominal pulsatile mass • A systolic bruit Chest pain and hypertension, although they may be present, are not indicators of AAA even if present. All other choices are positive.

Which of the following are alterations noted in Virchow's triad? Select all that apply. a) Vessel wall injury b) Stasis of blood c) Tenderness d) Edema e) Altered coagulation

• Stasis of blood • Altered coagulation • Vessel wall injury Three factors, known as Virchow's triad, are believed to play a significant role in the development of venous thrombosis. They are stasis of blood, vessel wall injury, and altered coagulation. Edema and tenderness are clinical manifestations of venous thrombosis, but are not part of the triad.

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 a good idea because it increases the metabolic rate." b) "It is better to soak your feet in hot water as long as the water temperature is below 110 degrees F." c) "It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet." d) "A heating pad to your feet is fine as long as the temperature stays below 105 degrees F."

"It is better to put the heating pad on your abdomen, which causes vasodilation and warmth to your feet." It is safer to apply a heating pad to the abdomen, causing a reflex vasodilation in the extremities. Heat may be applied directly to ischemic extremities; however, the temperature of the heating source must not exceed body temperature. Excess heat may increase the metabolic rate of the extremities and increase the need for oxygen beyond that provided by the reduced arterial flow through the diseased artery.

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

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

A 56-year-old woman with severe varicose veins has opted for venous ablation, and the nurse is providing patient education before the scheduled procedure. What instructions should the nurse provide to this patient? a) "If you notice any bruising in the area, make sure to let someone know because that could be a sign of a serious complication." b) "You might experience some pain after the procedure, but this will be managed with ice packs rather than medications." c) "We'll help you get walking as soon as you sedation has worn off, and you'll continue to gradually increase your activity level." d) "Try to limit your activity for the first 10 days to 2 weeks to prevent reoccurrence of your varicose veins."

"We'll help you get walking as soon as you sedation has worn off, and you'll continue to gradually increase your activity level."

A nursing instructor is discussing the diagnosis of intermittent claudication with students. To determine if the students understand the pathophysiology of the disease, the instructor asks, "What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?" a) 30 b) 20 c) 50 d) 40

50 Typically, about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced

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. surgical debridement B. enzymatic debridement C. hyperbaric oxygen D. vacuum-assisted closure device

hyperbaric oxygen

A client is being discharged home with a venous stasis ulcer on the right lower leg. Which topic will the nurse include in client teaching before discharge? a. Adequate carbohydrate intake b. Methods of keeping the wound area dry c. Prophylactic antibiotic therapy d.Application of graduated compression stockings

Application of graduated compression stockings Graduated compression stockings usually are prescribed for clients with venous insufficiency. The required pressure gradient is determined by the amount and severity of venous disease. Graduated compression stockings are designed to apply 100% of the prescribed pressure gradient at the ankle and pressure that decreases as the stocking approaches the thigh, reducing the caliber of the superficial veins in the leg and increasing flow in the deep veins. These stockings may be knee high, thigh high, or pantyhose.

A patient with a diagnosis of deep vein thrombosis (DVT) is being treated with unfractionated heparin, which is being administered intravenously. The nurse who is providing care for this patient should consequently prioritize what assessments? a) Monitoring the patient's intake and output, and assessing for signs of fluid volume deficit b) Assessing the patient's pain levels c) Assessing the patient for internal or external hemorrhage d) Assessing the patient for adventitious lung sounds and assessing SaO2 levels

Assessing the patient for internal or external hemorrhage

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) Attempt to palpate the dorsalis pedis and posterior tibial pulses. b) Check for the presence of tortuous veins bilaterally on the legs. c) Ask about any changes in skin color that occur in response to cold. d) Assess for unilateral swelling and tenderness of either leg.

Attempt to palpate the dorsalis pedis and posterior tibial pulses.

The nurse is caring for a client with Raynaud's disease. What are important instructions for a client who is diagnosed with this disease to prevent an attack? a) Avoid situations that contribute to ischemic episodes. b) Avoid fatty foods and exercise. c) Take over-the-counter decongestants. d) Report changes in the usual pattern of chest pain.

Avoid situations that contribute to ischemic episodes. Teaching for clients with Raynaud's disease and their family members is important. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants

The nurse is working with a client who has just been diagnosed with an aneurysm. What advice should the nurse provide to this client? a) Avoid situations that contribute to ischemic episodes. b) Wear wool socks and mittens during cold weather. c) Minimize bowel movements and coughing. d) Avoid straining during bowel movements and coughing.

Avoid straining during bowel movements and coughing.

When teaching a client with peripheral vascular disease about foot care, a nurse should include which instruction? a) Avoid wearing cotton socks. b) Avoid wearing canvas shoes. c) Avoid using a nail clipper to cut toenails. d) Avoid using cornstarch on the feet.

Avoid wearing canvas shoes. The client should be instructed to avoid wearing canvas shoes. Canvas shoes cause the feet to perspire, and perspiration can cause skin irritation and breakdown. Cotton and cornstarch absorb perspiration. The client should be instructed to cut toenails straight across with nail clippers

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless temporary change? a) Purplish stools b) Coldness of the soles c) Redness of the upper part of the feet d) Bluish urine

Bluish urine Lymphangiography may turn the urine blue temporarily; it doesn't alter stool color. For several months after the procedure, the upper part of the feet may appear blue, not red. Lymphangiography doesn't affect the soles.

Which observation regarding ulcer formation on the client's lower extremity indicates that the ulcer is a result of venous insufficiency? Border of the ulcer is irregular Is deep, involving the joint space Though superficial, it is very painful Base is pale to black

Border of the ulcer is irregular

Which of the following observations regarding ulcer formation on the patient's lower extremity indicates that the ulcer is a result of venous insufficiency? a) Is very painful to the patient, even though superficial b) Is deep, involving the joint space c) Border of the ulcer is irregular d) Base is pale to black

Border of the ulcer is irregular The border of an ulcer caused by arterial insufficiency is circular. Superficial venous insufficiency ulcers cause minimal pain. The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color. Venous insufficiency ulcers are usually superficial.

Which of the following is a characteristic of an arterial ulcer? a) Ankle-brachial index (ABI) > 0.90 b) Border regular and well demarcated c) Edema may be severe d) Brawny edema

Border regular and well demarcated Characteristics of an arterial ulcer include a border that is regular and demarcated. Brawny edema, ABI > 0.90, and edema that may be severe are characteristics of a venous ulcer.

A middle-aged male presents to the ED complaining of severe chest discomfort. Which of the following patient findings is most indicative of a possible MI? a) Cool, clammy, diaphoretic, and pale appearance b) Chest discomfort not relieved by rest or nitroglycerin c) Intermittent nausea and emesis for 3 days d) Anxiousness, restlessness, and lightheadedness

Chest discomfort not relieved by rest or nitroglycerin Chest pain or discomfort not relieved by rest or nitroglycerin is associated with an acute MI. The other findings, although associated with ACS (acute coronary syndrome) or MI, may also occur with angina and, alone, are not indicative of an MI.

A nurse is caring for a patient in the cardiovascular intensive care unit (CVICU) following a coronary artery bypass graft (CABG). Which of the following clinical findings requires immediate intervention by the nurse? a) CVP reading: 1 mmHg b) Blood pressure: 110/68 mmHg c) Heart rate: 66 bpm d) Pain score: 5/10.

CVP reading: 1 mmHg The central venous pressure (CVP) reading of 1 is low (2-6 mmHg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.

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) Obesity. b) Lack of exercise. c) Cigarette smoking. d) Stress.

Cigarette smoking. Nicotine decreases blood flow, increases heart rate and blood pressure, and increases the risk for clot formation by increasing platelet aggregation. Smokers have a four-fold higher risk of developing pain from arterial disease than nonsmokers. Carbon monoxide, produced by burning tobacco, combines with hemoglobin more readily than oxygen, thus depriving tissues of oxygen.

Pentoxifylline (Trental) is a medication used for which of the following conditions? a) Claudication b) Elevated triglycerides c) Hypertension d) Thromboemboli

Claudication Trental and Pletal are the only medications specifically indicated for the treatment of claudication. Thromboemboli, hypertension, and elevated triglycerides are not indications for using Trental.

Which of the following medications is given to patients diagnosed with angina and is allergic to aspirin? a) Amlodipine (Norvasc) b) Clopidogrel (Plavix) c) Felodipine (Plendil) d) Diltiazem (Cardizem)

Clopidogrel (Plavix) Plavix or Ticlid is given to patients who are allergic to aspirin or given in addition to aspirin to patients at high risk for MI. Norvasc, Cardizem, and Plendil are calcium channel blockers.

The nurse assesses a patient with hip pain related to intermittent claudication. She knows that the area of arterial narrowing is the: a) Anterior tibial. b) Common femoral artery. c) Posterior tibial. d) Common iliac artery.

Common iliac artery The location of the claudication occurs in muscle groups distal to the diseased vessel. Hip or buttock pain may result from reduced blood flow from the common iliac artery.

A health care provider wants a cross-sectional image of the abdomen to evaluate the degree of stenosis in a patient's left common iliac artery. The nurse knows to prepare the patient for which of the following? a) Doppler ultrasound b) Magnetic resonance angiography (MRA) c) Angiography d) Computed tomography angiography (CTA)

Computed tomography angiography (CTA) A CTA is used to visualize arteries and veins and help assess for stenosis and occlusion.

With a severe degree of peripheral arterial insufficiency, leg pain during rest can be reduced by: Elevating the limb over the heart level. Lowering the limb so that it is dependent. Massaging the limb after application of cold compresses. Placing the limb in a plane horizontal to the body.

Lowering the limb so that it is dependent.

Which risk factor is related to venous stasis for deep vein thrombosis (DVT) and pulmonary embolism (PE)?

Obesity Obesity is a risk factor for DVT and PE related to venous stasis. Trauma, pacing wires, and surgery are related to endothelial damage as a risk factor for DCAT and PE.

A nurse is caring for a patient who experienced an MI. The patient is ordered metoprolol (Lopressor). The nurse understands that the therapeutic effect of this medication is which of the following? a) Increases cardiac output b) Decreases resting heart rate c) Decreases cholesterol level d) Decreases platelet aggregation

Decreases resting heart rate The therapeutic effects of beta-adrenergic blocking agents such as metoprolol are to reduce the myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart. The result is reduced heart rate, slowed conduction of impulses through the conduction system, decreased blood pressure, and reduced myocardial contractility to balance the myocardial oxygen needs and amount of oxygen available. This helps to control chest pain and delays the onset of ischemia during work or exercise. This classification of medication also reduces the incidence of recurrent angina, infarction, and cardiac mortality. Generally the dosage of medication is titrated to achieve a resting heart rate of 50-60 bpm. Metoprolol is not administered to decrease cholesterol levels, increase cardiac output, or decrease platelet aggregation.

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

Demonstrate how to apply and remove elastic support stockings. The nurse demonstrates how to apply and remove elastic support stockings. Varicose veins do not require the nurse to demonstrate how to self-administer IV infusions. Varicose veins require the client to elevate legs regularly and perform leg exercises. However, it does not involve bleeding or skin lesions.

A woman has sought care from her nurse practitioner for the treatment of a wound on her lower leg that has been slow to heal. When planning this patient's care, what action should the nurse first perform? a) Take a culture and sensitivity swab from the wound bed. b) Prescribe the woman a course of broad-spectrum antibiotics. c) Cleanse the wound bed with normal saline and apply a hydrocolloid dressing. d) Determine whether the ulcer results from arterial insufficiency or venous insufficiency.

Determine whether the ulcer results from arterial insufficiency or venous insufficiency.

Which is a characteristic of arterial insufficiency? a) Pulses are present but may be difficult to palpate b) Diminished or absent pulses c) Aching, cramping pain d) Superficial ulcer

Diminished or absent pulses

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

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

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 15 to 20 minutes. c) Refrain from sexual activity for a week. d) Elevate the legs periodically for at least an hour.

Elevate the legs periodically for at least 15 to 20 minutes. The nurse should advise the client to periodically elevate the legs for at least 15 to 20 minutes. Avoiding foods with iodine or refraining from sexual activity for a week does not relate to venous insufficiency

When caring for a patient with leg ulcers, the positioning of the legs depends on whether the patient's ulcer is arterial or venous in origin. How should the nurse best position a patient who has leg ulcers that are venous in origin? a)Keep the patient's legs flat and straight. b)Keep the patient's knees bent to 45-degree angle and supported with pillows. c)Elevate the patient's lower extremities. d)Dangle the patient's legs over the side of the bed.

Elevate the patient's lower extremities.

You are caring for a client at risk for thrombosis. What is an appropriate nursing action when evaluating this client? a) Examine for pain around the shoulder and neck region. b) Examine the extremities for skin lesions. c) Examine the legs for color, capillary refill time, and tissue integrity. d) Examine the client's mental and emotional status.

Examine the legs for color, capillary refill time, and tissue integrity. The nurse examines the extremities and assesses skin color, temperature, capillary refill time, and tissue integrity and not for skin lesions for clients with thrombosis. Examining the client's mental and emotional status or examining for pain around the shoulder and neck region will not assist the nurse in evaluating a client with thrombosis.

A patient presents to the emergency room with characteristics of atherosclerosis. What characteristics would the patient display? a) Fatty deposits in the lumen of arteries b) Blood clots in the arteries c) Emboli in the veins d) Cholesterol plugs in the lumen of veins

Fatty deposits in the lumen of arteries Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. Therefore, options B, C, and D are incorrect.

Which class of medication lyses and dissolves thrombi? Fibrinolytic Platelet inhibitors Factor XA inhibitors Anticoagulant

Fibrinolytic

Which of the following medication classifications lyses and dissolves thrombi? a) Fibrinolytic b) Platelet inhibitors c) Factor XA inhibitors d) Anticoagulant

Fibrinolytic Thrombolytic (fibrinolytic) therapy lyses and dissolves thrombi in 50% of patients. Anticoagulants, platelet inhibitors, and factor XA inhibitors do no lyse or dissolve thrombi.

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) Decreased motor function. b) Thrombosis of the graft. c) Stent dislodgement. d) Hemorrhage.

Hemorrhage. All choices are serious and require medical/surgical intervention. However, hemorrhage is the most serious complication that requires immediate attention.

The lab values of a patient diagnosed with coronary artery disease (CAD) have just come back from the lab. His low-density lipoprotein (LDL) level is 112 mg/dL. This lab value is indicative of which of the following? a) High LDL level b) Normal LDL level c) Low LDL level d) Extremely high LDL level

High LDL level If the LDL level ranges from 100 mg/dL to 130 mg/dL, it is considered to be high. The goal is to decrease the LDL level below 100 mg/dL.

Which of the following in an inconsistent manifestation of metabolic syndrome? a) Hypotension b) Chronic inflammation c) Insulin resistance d) Dyslipidemia

Hypotension Metabolic syndrome consists of insulin resistance, dyslipidemia, hypertension, and chronic inflammation.

A new surgical patient who has undergone a coronary artery bypass graft (CABG) is receiving opioids for pain control. The nurse must be alert to adverse effects of opioids. Which of the following effects would be important for the nurse to document? a) Urinary incontinence b) Hypertension c) Hypotension d) Hyperactive bowel sounds

Hypotension The patient is observed for any adverse effects of opioids, which may include respiratory depression, hypotension, ileus, or urinary retention. If serious side effects occur, an opioid antagonist, such as Narcan, may be used.

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? a) Within the first 24 hours b) In 3 to 5 days c) In 2 days d) Within 12 hours

In 3 to 5 days

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? a) Within 12 hours b) In 2 days c) In 3 to 5 days d) Within the first 24 hours

In 3 to 5 days Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012).

Which of the following would be inconsistent as criterion of extubation in the patient who has undergone a coronary artery bypass graft (CABG)? a) Inability to speak. b) Adequate cough and gag reflex. c) Adequate vital capacity. d) Acceptable arterial blood gas (ABG) values.

Inability to speak. Before being extubated, the patient should have cough and gag reflexes and stable vital signs; be able to life the head off the bed or give firm hand grasps; have adequate vital capacity, negative inspiratory force, and minute volume appropriate for body size; and have acceptable ABG levels while breathing without the assistance of the ventilator. Inability to talk is expected when intubated with an endotracheal tube.

When the nurse notes that the post cardiac surgery patient demonstrates low urine output (less than 25 mL per hour) with high specific gravity (greater than 1.025), the nurse suspects which of the following conditions? a) Overhydration b) Anuria c) Inadequate fluid volume d) Normal glomerular filtration

Inadequate fluid volume Urine output of less than 25 mL per hour may indicate a decrease in cardiac output. A high specific gravity indicates increased concentration of solutes in the urine which occurs with inadequate fluid volume. Indices of normal glomerular filtration are output of 25 mLor greater per hour and specific gravity between 1.010 and 1.025. Overhydration is manifested by high urine output with low specific gravity. The anuric patient does not produce urine.

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? a) Acute limb ischemia b) Vertigo c) Dizziness d) Intermittent claudication

Intermittent claudication The hallmark symptom of PAD in the lower extremity is intermittent claudication. This pain may be described as aching or cramping in a muscle that occurs with the same degree of exercise or activity and is relieved with rest. Acute limb ischemia is a sudden decrease in limb perfusion, which produces new or worsening symptoms that may threaten limb viability. Dizziness and vertigo are associated with upper extremity arterial occlusive disease.

A client is receiving enoxaparin and warfarin therapy for a venous thromboembolism (VTE). Which laboratory value indicates that anticoagulation is adequate and enoxaparin can be discontinued? a) Activated partial thromboplastin time (aPPT) is half of the control value b) Prothrombin time (PT) is 0.5 times normal. c) K+ level is 3.5. d) International normalized ratio (INR) is 2.5.

International normalized ratio (INR) is 2.5. Oral anticoagulants such as warfarin are monitored by PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)

endothelial damage, venous stasis, and altered coagulation

List the classic triad (Virchow's) of factors associated with the development of venous thromboembolism.

Which of the following terms refers to enlarged, red, and tender lymph nodes? a) Lymphadenitis b) Lymphangitis c) Lymphedema d) Elephantiasis

Lymphadenitis Acute lymphadenitis is demonstrated by enlarged, red and tender lymph nodes. Lymphangitis is an acute inflammation of the lymphatic channels. Lymphedema is demonstrated by swelling of tissues in the extremities because of an increased quantity of lymph that results from an obstruction of lymphatic vessels. Elephantiasis refers to a condition in which chronic swelling of the extremity recedes only slightly with elevation.

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) No arterial insufficiency b) Moderate to severe arterial insufficiency c) Tissue loss to that foot d) Very mild arterial insufficiency

Moderate to severe arterial insufficiency Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

Which of the following discharge instructions for self-care should the nurse provide to a patient who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? a) Cleanse the site with disinfectants and dress the wound appropriately b) Normal activities of daily living can be resumed the first day post op c) Monitor the site for bleeding or hematoma. d) Refrain from sexual activity for one month

Monitor the site for bleeding or hematoma. The nurse provides certain discharge instructions for self-care, such as monitoring the site for bleeding or development of a hard mass indicative of hematoma. A nurse does not advise the patient to clean the site with disinfectants or refrain from sexual activity for one month.

A patient presents to the ED complaining of anxiety and chest pain after shoveling heavy snow that morning. The patient says that he has not taken nitroglycerin for months but did take three nitroglycerin tablets and although the pain is less, "They did not work all that well. " The patient shows the nurse the nitroglycerin bottle and the prescription was filled 12 months ago. The nurse anticipates which of the following physician orders? a) Nitroglycerin SL b) Chest x-ray c) Ativan 1 mg orally d) Serum electrolytes

Nitroglycerin SL Nitroglycerin is volatile and is inactivated by heat, moisture, air, light, and time. Nitroglycerin should be renewed every 6 months to ensure full potency. The client's tablets were expired and the nurse should anticipate administering nitroglycerin to assess if the chest pain subsides. The other choices may be ordered at a later time, but the priority is to relieve the patient's chest pain.

The nurse is performing wound care for a patient with a necrotic sacral wound. The prescribed treatment is isotonic saline solution with fine mesh gauze and a dry dressing to cover. What type of debridement is the nurse performing? a) Enzymatic debridement b) Selective debridement c) Nonselective debridement d) Surgical debridement

Nonselective debridement Nonselective débridement can be accomplished by applying isotonic saline dressings of fine mesh gauze to the ulcer. When the dressing dries, it is removed (dry), along with the debris adhering to the gauze. Pain management is usually necessary.

Which is a risk factor for venous disorders of the lower extremities? a) Obesity b) Surgery c) Pacing wires d) Trauma

Obesity

A client with Raynaud's disease complains of cold and numbness in the fingers. Which of the following would the nurse identify as an early sign of vasoconstriction? Gangrene Clubbing of the fingers Cyanosis Pallor

Pallor

The nurse recognizes that the treatment for a non-ST elevation myocardial infarction (NSTEMI) differs from that of a patient with a STEMI, in that a STEMI is more frequently treated with which of the following? a) IV nitroglycerin b) Percutaneous coronary intervention (PCI) c) Thrombolytics d) IV heparin

Percutaneous coronary intervention (PCI) The patient with a STEMI is often taken directly to the cardiac catheterization laboratory for an immediate PCI. Superior outcomes have been reported with the use of PCI compared to thrombolytics. IV heparin and IV nitroglycerin are used to treat NSTEMI.

Postpericardiotomy syndrome may occur in patients who undergo cardiac surgery. The nurse should be alert to which of the following clinical manifestations associated with this syndrome? a) Decreased erythrocyte sedimentation rate (ESR) b) Decreased white blood cell (WBC) count c) Hypothermia d) Pericardial friction rub

Pericardial friction rub The syndrome is characterized by fever, pericardial pain, pleural pain, dyspnea, pericardial effusion, pericardial friction rub, and arthralgia. Leukocytosis (elevated WBCs) occurs, along with elevation of the ESR.

A patient complains of a "stabbing pain and a burning sensation" in his left foot. The nurse notices that the foot is a lighter color than the rest of the skin. The artery that the nurse suspects is occluded would be the: Posterior tibial. Popliteal. Common femoral. Internal iliac.

Posterior tibial.

Which of the following is the most effective intervention for preventing progression of vascular disease? a) Risk factor modification b) Use neutral soaps c) Avoid trauma d) Wear sturdy shoes

Risk factor modification Risk factor modification is the most effective intervention for preventing progression of vascular disease. Measures to prevent tissue loss and amputation are a high priority. Patients are taught to avoid trauma; wear sturdy, well-fitting shoes or slippers; and use pH neutral soaps and body lotions.

A nurse is admitting a new client with a deep vein thrombosis in her left leg. During the admission process, which information provided by the client would be a contraindication to anticoagulant therapy? Three vaginal births, the most recent 18 months ago Scheduled eye surgery in 1 week Diet that includes many green, leafy vegetables every day A cerebral vascular bleed 10 years ago

Scheduled eye surgery in 1 week

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? Hematemesis Hypertensive crisis Rectal bleeding Severe back pain

Severe back pain

During his annual physical exam, a 62-year-old male client reports experiencing chest pain and palpitations during and after his morning jogs. Family history reveals coronary artery disease. The nurse should instruct the client in the following to reduce the client's cardiac risk? a) Smoking cessation b) Antioxidant supplements c) Exercise avoidance d) Protein-rich diet

Smoking cessation The first line of defense for clients with CAD is lifestyle changes including smoking cessation, weight loss, stress management, and exercise. Clients with CAD should eat a balanced diet. Clients with CAD should exercise, as tolerated, to maintain a healthy weight. Antioxidant supplements, such as those containing vitamin E, beta carotene, and selenium, are not recommended because clinical trials have failed to confirm beneficial effects from their use.

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

Teach the client how to apply a graduated compression stocking.

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

Teach the client how to apply an elastic sleeve

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 can walk about 50 feet before getting pain in the right lower leg. c) The client's fingers tingle when left in one position for too long. d) The client's legs awaken him during the night with itching.

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

A patient is receiving enoxaparin (Lovenox) and warfarin (Coumadin) therapy for a venous thromboembolism (VTE). Which lab value indicates that anticoagulation is adequate and enoxaparin (Lovenox) can be discontinued? a) The patient's activated partial thromboplastin time (aPPT) is half of the control value. b) The patient's K+ level is 3.5. c) The patient's prothrombin time (PT) is 0.5 times normal. d) The patient's international normalized ratio (INR) is 2.5.

The patient's international normalized ratio (INR) is 2.5. Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (ie, when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)

The most important factor regulating the caliber of blood vessels, which determines resistance to flow, is: a) The influence of circulating chemicals. b) Independent arterial wall activity. c) The sympathetic nervous system. d) Hormonal secretion.

The sympathetic nervous system. Stimulation of the sympathetic nervous system causes vasoconstriction thus regulating blood flow. Norepinephrine is the responsible neurotransmitter.

The patient has had biomarkers drawn after complaining of chest pain. Which diagnostic of myocardial infarction remains elevated for as long as 3 weeks? a) Troponin b) CK-MB c) Myoglobin d) Total CK

Troponin Troponin remains elevated for a long period, often as long as 3 weeks, and it therefore can be used to detect recent myocardial damage. Myoglobin returns to normal in 12 hours. Total CK returns to normal in 3 days. CK-MB returns to normal in 3 to 4 days.

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? Loose and wrinkled skin Evident scaring Ulcers and infection in the edematous area Cyanosis

Ulcers and infection in the edematous area

What are the symptoms a nurse should assess for in a patient with lymphedema as a result of impaired nutrition to the tissue? a) Evident scaring b) Ulcers and infection in the edematous area c) Loose and wrinkled skin d) Cyanosis

Ulcers and infection in the edematous area In a patient with lymphedema, the tissue nutrition is impaired from the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area. Later, the skin also appears thickened, rough, and discolored. Scaring does not occur in patients with lymphedema, and cyanosis is a bluish discoloration of the skin and mucous membranes.

When the patient diagnosed with angina pectoris complains that he is experiencing chest pain more frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse recognizes that the patient is describing which type of angina? a) Refractory b) Intractable c) Variant d) Unstable

Unstable Unstable angina is also called crescendo or preinfarction angina and indicates the need for a change in treatment. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment. Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be caused by coronary artery vasospasm. Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to conventional treatment.

The nurse is caring for a client who is scheduled to have a vein ligation in the morning. How would you describe a vein ligation to the client? a) Removal of the great saphenous vein. b) Removal of the small saphenous vein. c) Veins are tied off and removed. d) Veins are tied off and left in the leg.

Veins are tied off and left in the leg. A vein ligation is a procedure in which the affected veins are ligated (tied off) above and below the area of incompetent valves, but the dysfunctional vein remains. A vein stripping is the removal of the veins after being tied off.

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) a lymphoscintigraphy. b) a contrast phlebography. c) an air plethysmography. d) a lymphangiography.

a contrast phlebography. When a thrombus exists, an x-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In a lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.

A nurse is caring for a client who is exhibiting signs and symptoms characteristic of a myocardial infarction (MI). Which statement describes priorities the nurse should establish while performing the physical assessment? a) Assess the client's level of pain and administer prescribed analgesics. b) Ensure that the client's family is kept informed of his status. c) Prepare the client for pulmonary artery catheterization. d) Assess the client's level of anxiety and provide emotional support.

a) Assess the client's level of pain and administer prescribed analgesics. The cardinal symptom of MI is persistent, crushing substernal pain or pressure. The nurse should first assess the client's pain and prepare to administer nitroglycerin or morphine for pain control. The client must be medically stabilized before pulmonary artery catheterization can be used as a diagnostic procedure. Anxiety and a feeling of impending doom are characteristic of MI, but the priority is to stabilize the client medically. Although the client and his family should be kept informed at every step of the recovery process, this action isn't the priority when treating a client with a suspected MI.

When caring for a client with a diagnosis of aortic aneurysm scheduled for surgery, what would be most important for the nurse to monitor? a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection b) Intake and output, nutrition level, respirations, and characteristics of pain c) Cultural needs, characteristics of pain, and signs of hemorrhage or dissection d) BP, pulse, respirations, and signs of hemorrhage or dissection

a) Level of consciousness, characteristics of pain, and signs of hemorrhage or dissection The nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional levels, and cultural needs are important but not the most important assessments for the nurse to make.

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer an: a) anticonvulsant. b) antihypertensive. c) anticoagulant. d) antibiotic.

a) anticoagulant. During PTCA, the client receives heparin, an anticoagulant, as well as calcium agonists, nitrates, or both, to reduce coronary artery spasm. Nurses don't routinely give antibiotics during this procedure; however, because the procedure is invasive, the client may receive prophylactic antibiotics to reduce the risk of infection. An antihypertensive may cause hypotension, which should be avoided during the procedure. An anticonvulsant isn't indicated because this procedure doesn't increase the risk of seizures.

The most common site of aneurysm formation is in the: a) abdominal aorta, just below the renal arteries. b) aortic arch, around the ascending and descending aorta. c) ascending aorta, around the aortic arch. d) descending aorta, beyond the subclavian arteries.

abdominal aorta, just below the renal arteries. About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debakey type III aneurysms occur in the descending aorta, beyond the subclavian arteries

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) Elevation of the legs above the heart b) Keeping the legs in a neutral or dependent position c) Application of ace wraps from the toe to below the knees d) Use of antiembolytic stockings

b) Keeping the legs in a neutral or dependent position Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.

The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise: a) aids in weight reduction. b) decreases venous congestion. c) reduces stress. d) increases high-density lipoprotein (HDL) level.

decreases venous congestion. Regular walking is the best way to decrease venous congestion because using the leg muscles as a pump helps return blood to the heart. Regular exercise also aids in stress reduction and weight reduction and increases the formation of HDLs — which are all beneficial to a client with peripheral vascular disease. However, these changes don't have as significant an effect on the client's condition as decreasing venous congestion.

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) dependent pallor. b) a 30-second filling time for the veins. c) no rubor for 10 seconds after the maneuver. d) elevational rubor.

dependent pallor. If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves.

A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionalist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time? A. metoprolol (Lopressor) B. epinephrine C. hydrocortisone (Solu-Cortef) D. cimetidine (Tagamet)

epinephrine

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

forcing blood into the deep venous system. Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT.

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) keep the affected leg level or slightly dependent. b) shave the affected leg in anticipation of surgery. c) elevate the affected leg as high as possible. d) place a heating pad around the affected calf.

keep the affected leg level or slightly dependent. While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

Vasodilation or vasoconstriction produced by an external cause will interfere with a nurse's accurate assessment of a client with peripheral vascular disease (PVD). Therefore, the nurse should: a) maintain room temperature at 78° F (25.6° C). b) keep the client uncovered. c) keep the client warm. d) match the room temperature to the client's body temperature.

keep the client warm. The nurse should keep the client covered and expose only the portion of the client's body that she's assessing. The nurse should also keep the client warm by maintaining his room temperature between 68° F and 74° F (20° and 23.3° C). Extreme temperatures aren't good for clients with PVD. The valves in their arteries and veins are already insufficient, and exposing them to vast changes in temperature could affect assessment findings. Keeping the client uncovered would cause him to become chilled. Matching the room temperature to the client's body temperature is inappropriate.

The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics? a) Superficial ulcer b) Aching, cramping pain c) Diminished or absent pulses d) Pulses are present, may be difficult to palpate

Diminished or absent pulses Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency

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

"I have my wife look at the soles of my feet each day." A client with peripheral vascular disease should examine his feet daily for redness, dryness, or cuts. If a client isn't able to do this examination on his own, then a caregiver or family member should help him. A client with peripheral vascular disease should avoid hot tubs because decreased sensation in the feet may make him unable to tell if the water is too hot. The client should always wear shoes or slippers on his feet when he is out of bed to help minimize trauma to the feet. Any type of nicotine, whether it's from cigarettes or smokeless tobacco, can cause vasoconstriction and further decrease blood supply to the extremities.

Which aneurysm occurs as a result of infection at arterial suture or graft sites? a) Dissecting b) Anastomotic c) False d) Saccular

Anastomotic An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites. Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma

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) Slow heart rate and high blood pressure b) Constant, intense back pain and falling blood pressure c) Higher than normal blood pressure and falling hematocrit d) Constant, intense headache and falling blood pressure

Constant, intense back pain and falling blood pressure Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

Which aneurysm results in bleeding into the layers of the arterial wall? Saccular Dissecting False Anastomotic

Dissecting Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma. An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites.

Which statement is accurate regarding Reynaud disease?

Episodes may be triggered by unusual sensitivity to cold. Episodes of Reynaud disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits.

Aortic dissection may be mistaken for which of the following disease processes? a) Myocardial infarction (MI) b) Angina c) Stroke d) Pneumothorax

Myocardial infarction (MI) Aortic dissection may be mistaken for an acute MI, which could confuse the clinical picture and initial treatment. Aortic dissection is not mistaken for stroke, pneumothorax, or angina.

What should the nurse do to manage the persistent swelling in a patient with severe lymphangitis and lymphadenitis? a) Inform the physician if the temperature remains low. b) Teach the patient how to apply a graduated compression stocking. c) Avoid elevating the area. d) Offer cold applications to promote comfort and to enhance circulation.

Teach the patient how to apply a graduated compression stocking. In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the patient how to apply a graduated compression stocking. The nurse informs the physician if the temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

List the six clinical symptoms associated with the acute arterial embolism, also known as the six Ps.

pain, pallor, pulselessness, paresthesia, poikilothermia, paralysis