Chapter 30 Vascular Disorders and Problems of Peripheral Circulation

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

a) Dissecting Dissection = rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall - Saccular = collect blood in the weakened outpouching - False = the mass is actually a pulsating hematoma - Anastomotic = occurs as a result of infection at arterial suture or graft sites

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

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

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

a) 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 manifestation of peripheral arterial disease in a client who describes intermittent claudication. A thorough assessment of the client's skin color and temperature and the character of the peripheral pulses are important in the diagnoses of arterial disorders

A client is receiving enoxaparin and warfarin therapy for a venous thromboembolism (VTE). Which lab value indicates that anticoagulation is adequate and enoxaparin can be discontinued? a) INR = 2.5 b) PT is 0.5 times normal c) aPTT is half of the control value d) Potassium level is 3.5

a) INR is 2.5

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

a) Intermittent claudication Intermittent claudication = leg pain brought on by exercise and relieved by rest; Dyspnea = difficulty breathing and is subjective; Orthopnea = inability to breathe except in the upright (sitting) position; Thromboangiitis obliterans is a peripheral vascular disease also known as Buerger disease

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

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

A nurse is caring for a client following an arterial vascular bypass graft in the leg. Which should the nurse plan to assess over the next 24 hours? a) Peripheral pulses every 15 minutes after surgery b) BP every 2 hours c) Color of the leg every 4 hours d) Ankle-are indices every 12 hours

a) Peripheral pulses every 15 minutes after 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

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

a) Teach the client how to apply an elastic sleeve

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

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

A community health nurse teaches a group of older adults 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 statement? a) "Because my family is from Italy, I have a higher risk of developing peripheral arterial disease" b) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet" c) "The older I get the higher my risk for peripheral arterial disease gets" d) "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels"

b) "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 - vasoconstriction = decreased arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets

Which diagnostic test is used to quantify venous reflux and calf muscle pump ejection? a) Contrast phlebography b) Air plethysmography c) Lymphoscintigraphy d) Lymphangiography

b) Air plethysmography

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

b) 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 a beefy red to fibrinous yellow color. Venous insufficiency ulcers are usually superficial

The nurse is 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

b) Diminished or absent pulses

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

b) 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.

Which risk factor is related to venous stasis for deep vein thrombosis (DVT) and pulmonary embolism (PE)? a) Trauma b) Obesity c) Pacing wires d) Surgery

b) 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

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

b) Ulcers and infection in the edematous area

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

c) "I will call if I develop any coldness, numbness, tingling, or pain the surgical leg"

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

c) "The enoxaparin will work immediately, but the warfarin takes several days to achieve 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 (i.e., when the PT is 1.5-2 times normal or the INR is 2.0-3.0)

A nursing instructor is discussing the diagnosis of intermittent claudication with students. To determine whether 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?" What answer should the students give? a) 30 b) 20 c) 50 d) 40

c) 50

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

c) Anastomotic

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

c) 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

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

c) Fibrinolytic Thrombolytic (fibrinolytic) therapy lyses and dissolves thrombi in 50% of clients. Anticoagulants, platelet inhibitors, and factor XA inhibitors do not lyse or dissolve thrombi

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? a) Changes in bowel and bladder habits b) Back or lumbar pain c) Hoarse voice and difficulty swallowing d) Abdominal swelling and tenderness

c) Hoarse voice and difficulty swallowing Symptoms are dyspnea, the result of pressure of the aneurysm sac against the trachea, a main bronchus, or the lung itself; cough, frequently paroxysmal and with a brassy quality; hoarseness, stridor, or weakness or complete loss of the voice (aphonia), resulting from pressure against the laryngeal nerve; and dysphagia (difficulty in swallowing) due to impingement of the aneurysm on the esophagus

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

c) Intermittent claudication

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

c) Intermittent claudication

Which observation regarding ulcer formation on the client's lower extremity indicates to the nurse that the ulcer is a result of venous insufficiency? a) is deep, involving the joint space b) Base is pale to black c) Large and superficial d) Though superficial, is very painful

c) Large and superficial Ulcerations are in the area of the medial or lateral malleolus (gaiter area) and are typically large, superficial, and high exudative. Superficial venous insufficiency ulcers cause minimal pain. The base of a venous insufficiency ulcer shows a beefy red to yellow fibrinous color

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

c) Obesity

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

c) Ulcers and infection in the edematous area In a client with lymphedema, the tissue nutrition is impaired as a result of stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area. Later, the skin also appears thickened, rough, and discolored.

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) air plethysmography b) lymphangiography c) contrast phlebography d) lymphoscintigraphy

c) 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 - Lymphangiography: contrast media are injected into the lymph system - Lymphoscintigraphy = radioactive-labeled colloid is injected into the lymph system

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? a) Saccular b) False c) Dissecting d) Anastomotic

d) Anastomotic

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) Methods of keeping the wound area dry b) Prophylactic antibiotic therapy c) Adequate carbohydrate intake d) Application of graduated compression stockings

d) 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 angle and pressure that decreases as the stocking approaches the thigh, reducing the caliber of the superficial veins in the leg and increasing the flow in the deep veins

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

d) 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

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

d) The aneurysm may be preparing to rupture Signs of impending rupture = severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized to 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 AAA include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is quickly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

The nurse teaches the client with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes a) depresses the cough reflex b) causes diuresis c) slows the heart rate d) causes vasospasm

d) causes vasospasm Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities