Chapter 30: Assessment and Management of Patients with Vascular Disorders

A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time?

Epinephrine

A nurse is caring for a client following an arterial vascular bypass graft in the leg. What should the nurse plan to assess over the next 24 hours

Peripheral pulses every 15 minutes after surgery

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?

Stabilizing heart rate and blood pressure and easing anxiety

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."

To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the:

Anterior surface of the foot near the ankle joint.

Which assessment finding by the nurse is the most significant finding suggestive of aortic aneurysm?

Abdomen bruit

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?

Arterial insufficiency

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?

Attempt to palpate the dorsalis pedis and posterior tibial pulses.

A client is recovering from surgical repair of a dissecting aortic aneurysm. Which assessment findings indicate possible bleeding or recurring dissection?

Blood pressure of 82/40 mm Hg and heart rate of 125 beats/minute

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless temporary change?

Bluish urine

Pentoxifylline (Trental) is a medication used for which of the following conditions?

Claudication

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following?

Constant, intense back pain and falling blood pressure

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?

Contrast phlebography

The clinic nurse caring for a client with a cardiovascular disorder is performing an assessment of the client's pulse. Which of the following steps is involved in determining the pulse deficit?

Count the heart rate at the apex.

Which is a characteristic of arterial insufficiency?

Diminished or absent pulses

A client is being scheduled for a stress test. The client is unable to exercise during the test. The nurse would include information about which medication used for pharmacologic stress testing?

Dipyridamole

Which aneurysm results in bleeding into the layers of the arterial wall?

Dissecting

A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg?

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

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

Hemorrhage

A patient with diabetes is being treated for a wound on the lower extremity that has been present for 30 days. What option for treatment is available to increase diffusion of oxygen to the hypoxic wound?

Hyperbaric chamber

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending?

Increased abdominal and back pain

A client is diagnosed with deep vein thrombosis (DVT) Which nursing diagnosis should receive the highest priority at this time?

Ineffective peripheral tissue perfusion related to venous congestion

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 shoud:

Keep the affected leg level or slightly dependent

With a severe degree of peripheral arterial insufficiency, leg pain during rest can be reduced by

Lowering the limb so that it is dependent

Aortic dissection may be mistaken for which of the following disease processes?

Myocardial infarction (MI)

The client's heart rate is observed to be 140 bpm on the monitor. The nurse knows to monitor the client for what condition?

Myocardial ischemia

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?

Pallor

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 would be the

Posterior tibial

A client with systemic lupus erythematosus (SLE) complains that his hands became pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these sign and symptoms?

Raynaud's disease

A female client is readmitted to the facility with a warm, tender, reddened are on her right calf. Which contributing factor should the nurse recognize as most important?

Recent pelvic surgery

It is important for a nurse to understand cardiac hemodynamics. For blood to flow from the right ventricle to the pulmonary artery, the following must occur:

Right ventricular pressure must be higher than pulmonary arterial pressure.

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

Severe back pain

Which of the following are alterations noted in VIRCHOW'S TRIAD? Select all that apply.

Stasis of blood. Vessel wall injury. Altered coagulation.

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?

Taking daily walks

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?

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

A client admitted to the medical-surgical unit with a venous thromboembolism (VTE) is started on enoxaparain and warfarin. The client asks the nurse why two medications are needed. Which response by the nurse is accurate?

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

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

There is severe edema to the client's legs and abdomen

Which symptoms should the nurse asses for in a client with lymphedema as a result of impaired nutrition to the tissue?

Ulcers and infection in the edematous area

The nurse teaches the client with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes

Vasospasm

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?

Venous insufficiency

The most common site of aneurysm formation is in the:

abdominal aorta, just below the renal arteries.