Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation
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) "The older I get the higher my risk for peripheral arterial disease gets." b) "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." c) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." d) "Since my family is from Italy, I have a higher risk of developing peripheral arterial disease."
"I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet."
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."
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.
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 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.
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
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.
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.
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) Venous insufficiency b) Neither venous nor arterial c) Trauma d) Arterial insufficiency
Arterial insufficiency
You are presenting a workshop at the senior citizens center about how the changes of aging predisposes clients to vascular occlusive disorders. What would you name as the most common cause of peripheral arterial problems in the older adult? a) Aneurysm b) Coronary thrombosis c) Atherosclerosis d) Raynaud's disease
Atherosclerosis
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) Redness of the upper part of the feet c) Coldness of the soles d) Bluish urine
Bluish urine
Which of the following is a characteristic of an arterial ulcer? a) Edema may be severe b) Border regular and well demarcated c) Brawny edema d) Ankle-brachial index (ABI) > 0.90
Border regular and well demarcated
Pentoxifylline (Trental) is a medication used for which of the following conditions? a) Elevated triglycerides b) Claudication c) Hypertension d) Thromboemboli
Claudication
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 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) Higher than normal blood pressure and falling hematocrit c) Constant, intense back pain and falling blood pressure d) Constant, intense headache and falling blood pressure
Constant, intense back pain and falling blood pressure
As the clinic nurse caring for a client with varicose veins, what is an appropriate nursing action for this client? a) Demonstrate how to apply and remove elastic support stockings. b) Demonstrate how to self-administer IV infusions. c) Assess for the sites of bleeding. d) Assess for skin integrity.
Demonstrate how to apply and remove elastic support stockings.
Which of the following are characteristics of arterial insufficiency? a) Superficial ulcer b) Pulses are present, may be difficult to palpate c) Diminished or absent pulses d) Aching, cramping pain
Diminished or absent pulses
Which of the following aneurysms results in bleeding into the layers of the arterial wall? a) Saccular b) False c) Dissecting d) Anastomotic
Dissecting
Which of the following medication classifications lyses and dissolves thrombi? a) Fibrinolytic b) Platelet inhibitors c) Factor XA inhibitors d) Anticoagulant
Fibrinolytic
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
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.
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) Homans' c) Romberg's d) Phalen's
Homans'
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
Aortic dissection may be mistaken for which of the following disease processes? a) Pneumothorax b) Stroke c) Myocardial infarction (MI) d) Angina
Myocardial infarction (MI)
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
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) Peripheral pulses every 15 minutes following surgery b) Ankle-arm indices every 12 hours c) Color of the leg every 4 hours d) Blood pressure every 2 hours
Peripheral pulses every 15 minutes following surgery
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
What should the nurse do to manage the persistent swelling in a patient with severe lymphangitis and lymphadenitis? a) Teach the patient how to apply a graduated compression stocking. b) Offer cold applications to promote comfort and to enhance circulation. c) Avoid elevating the area. d) Inform the physician if the temperature remains low.
Teach the patient how to apply a graduated compression stocking.
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 may be preparing to rupture. c) The patient is experiencing normal sensations associated with this condition. d) The aneurysm has become obstructed.
The aneurysm may be preparing to rupture.
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 international normalized ratio (INR) is 2.5. b) The patient's K+ level is 3.5. c) The patient's activated partial thromboplastin time (aPPT) is half of the control value. d) The patient's prothrombin time (PT) is 0.5 times normal.
The patient's international normalized ratio (INR) is 2.5.
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.
Which of the following is the most common site for a dissecting aneurysm? a) Lumbar area b) Thoracic area c) Cervical area d) Sacral area
Thoracic area
The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is a) a lymphoscintigraphy. b) an air plethysmography. c) a lymphangiography. d) a contrast phlebography.
a contrast phlebography.
The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes a) a slowed heart rate. b) diuresis. c) depression of the cough reflex. d) a vasospasm.
a vasospasm.
The most common site of aneurysm formation is in the: a) aortic arch, around the ascending and descending aorta. b) abdominal aorta, just below the renal arteries. c) ascending aorta, around the aortic arch. d) descending aorta, beyond the subclavian arteries.
abdominal aorta, just below the renal arteries.
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.
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.
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.
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.
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
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
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
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