Peripheral Vascular Disease Practice Questions

The nurse provides discharge instructions to a client who is diagnosed with peripheral arterial disease (PAD). Which client statement indicates a need for further instruction from the nurse? Select all that apply. A. "A heating pad should be used to restore circulation." B. "Anytime I am resting, I should elevate my legs." C. "I will begin walking around the neighborhood." D. "Moisturizing lotion should be applied to my legs daily." E. "Swelling is an expected finding with this disorder."

A. "A heating pad should be used to restore circulation." This client statements alerts the nurse to the need for further teaching. Heating pads could cause significant tissue damage in a client with PAD due to peripheral neuropathy as the client may be unable to detect burning of the skin. B. "Anytime I am resting, I should elevate my legs." This client statement alerts the nurse to the need for further teaching. Clients with PAD should not elevate their legs for long periods as this further decreases circulation to the extremities. E. "Swelling is an expected finding with this disorder." This client statement indicates a need for additional instruction by the nurse. Edema (i.e, swelling) is expected in clients with peripheral venous insufficiency; however, this is not an expected finding in clients with PAD.

A home health nurse is caring for a client with peripheral vascular disease​ (PVD). When teaching the client regarding foot and leg​ care, which statement should the nurse​ include? (Select all that​ apply.) A. ​"Dry between your toes after​ showering."​ B. "Apply moisturizing cream to feet and legs​ daily." C. ​"Buy shoes in the​ morning, when feet are​ largest." D. ​"Avoid using powder on your​ feet." E. ​"When swimming, ensure the water is​ cool, not​ warm."

A. "Dry between your toes after​ showering." B. ​"Apply moisturizing cream to feet and legs​ daily. "Foot and leg care for clients with PVD includes applying moisturizing cream to feet and legs daily as well as drying between the toes after showering. The client should use powder on the feet to keep feet dry. When​ swimming, water should be warm because cool water causes​ vasospasm, worsening the​ client's condition. The client should buy shoes in the​ afternoon, when feet are largest.

You're assessing a patient's health history for peripheral vascular disease. What signs and symptoms reported by the patient would indicate the patient may be experiencing peripheral arterial disease? Select all that apply: A. "I often wake up at night with leg pain and have to dangle my leg out of the bed to ease the pain." B. "If I stand or sit too long my legs start to feel heavy and achy." C. "It hurts to elevate my legs." D. "Sometimes when I'm walking my legs start to cramp and tingle to the point where I can't walk until the pain goes away."

A. "I often wake up at night with leg pain and have to dangle my leg out of the bed to ease the pain." C. "It hurts to elevate my legs." D. "Sometimes when I'm walking my legs start to cramp and tingle to the point where I can't walk until the pain goes away." The answers are A, C, and D. Peripheral arterial disease occurs when there is impediment of blood flow to the lower extremities (hence the lower extremities are being deprived of blood flow and this causes pain). The pain most commonly occurs at night and can wake up the patient. It is known as "rest pain". This occurs because when the legs are horizontal the blood flow is compromised and it causes pain...therefore the patient will report they dangle the leg off the bed to help ease the pain (the dependent position (dangling) will help blood flow down to the extremity). In addition, it hurts to elevate the legs (again because this further compromises blood flow). Option B occurs in peripheral venous disease. Option D is known as intermittent claudication and is a HALLMARK sign and symptom in PAD.

The nurse is preparing to teach a client with a venous stasis ulcer on the left lower leg. Which intervention should the nurse include in the teaching​ plan? A. Application of elastic compression stockings B. Purpose of antibiotic therapy C. Increased carbohydrate intake to promote wound healing D. How to keep the wound bed clean and dry

A. Application of elastic compression stockings Use of elastic compression stockings is essential to healing of venous stasis ulcers. High dietary intake of​ protein, rather than​ carbohydrates, is needed for wound healing. Antibiotics are not routinely used for venous ulcers. Moist dressings are used for venous stasis​ ulcers, not dry dressings.

The nurse provides care for a client who presents to the emergency department (ED) with suspected hypovolemic shock. Which assessment is the best indicator of sufficient peripheral perfusion for this client? Select all that apply. A. Capillary refill < 3 seconds B. Heart rate of 62 beats/minute C. Oxygen saturation of 90% D. Moves extremities on command E. Warm, pink extremities

A. Capillary refill < 3 seconds A capillary refill that is less than 3 seconds indicates blood flow or perfusion peripherally. Adequate peripheral perfusion in a client with suspected hypovolemic shock indicates the compensatory mechanisms have not been activated thus intervention during this initial stage will prevent hypovolemic shock from progressing to the compensatory, progressive, and irreversible stages of shock. E. Warm, pink extremities Warm, pink extremities indicate blood flow or perfusion peripherally; therefore, this data indicates the compensatory mechanisms have not been activated. Hopefully, intervention during this initial stage will prevent hypovolemic shock from progressing to the compensatory, progressive, and irreversible stages of shock.

Select below all the characteristics that can present with an arterial ulcer: A. Found on the lateral malleolus, dorsum of foot, or end of toes B. Found on the medial malleolus or medial part of lower leg C. Deep, round, defined edges and has a "punched out" appearance D. Minimal drainage E. Edematous F. Brown pigmented skin surrounding the ulcer G. Wound base is pale

A. Found on the lateral malleolus, dorsum of foot, or end of toes C. Deep, round, defined edges and has a "punched out" appearance D. Minimal drainage G. Wound base is pale The answers are A, C, D, and G. Arterial ulcers have very little blood flow to them so they will be pale (little granulation) and have little (if any) drainage. They will be deep, round, and have a "punched out" appearance. They are most commonly found on the lateral malleolus, dorsum of foot, or end of toes.

The nurse is talking to a client with peripheral vascular disease​ (PVD) who reports using biofeedback as a complementary therapy. The nurse knows this serves which purpose for​ PVD? A. Improving peripheral circulation B. Decreasing arterial plaque buildup C. Reducing stress D. Lowering overall cholesterol

A. Improving peripheral circulation Biofeedback is used to improve peripheral​ circulation; biofeedback does not reduce plaque buildup. Exercise and a change in diet can reduce overall cholesterol and slow the progress of PVD. Many alternative therapies are used to reduce​ stress, but that is not a main function of biofeedback.

The nurse is assessing a client diagnosed with chronic vascular insufficiency​ (CVI). Which assessment finding should the nurse​ expect? (Select all that​ apply.) A. Lower extremity edema B. Cyanosis of lower legs C. Soft subcutaneous tissue on affected areas on leg D. Excessive hair growth on the legs E. Pale skin on lower legs

A. Lower extremity edema B. Cyanosis of lower legs Manifestations of CVI include lower extremity edema that worsens with​ standing; itching, dull leg discomfort or pain that increases with​ standing; thin,​ shiny, atrophic​ skin; cyanosis and brown skin pigmentation of lower leg and​ foot; possible weeping​ dermatitis; thick, fibrous​ (hard) subcutaneous​ tissue; and recurrent ulcerations of medial or anterior ankles.

A patient is diagnosed with Raynaud's Disease. Which explanations below most accurately describe this condition? Select all that apply: A. Raynaud's Disease is triggered by cold temperatures or stress. B. Raynaud's Disease occurs due to a vasospasm of the peripheral veins. C. Raynaud's Disease affects the toes, fingers, and sometimes the ears and nose. D. Raynaud's Disease is prevented by glucose control.

A. Raynaud's Disease is triggered by cold temperatures or stress. C. Raynaud's Disease affects the toes, fingers, and sometimes the ears and nose. The answers are A and C. Raynaud's Disease occurs when vasospasm of peripheral arteries occurs. It mainly affects the fingers and toes (it can also affect the ears/nose). It is triggered by exposure to cold or during stress. It can be prevented by keeping the toes, fingers, ears, and nose warm and avoid stress. Medications can also be used as well that help prevent vasospasm.

Your patient has severe peripheral venous disease. During the head-to-toe nursing assessment, you would expect to find what skin characteristics of the lower extremities? Select all that apply: A. Thick, tough B. Thin, scaly C. Hairless D. Brown pigmented

A. Thick, tough D. Brown pigmented The answers are A and D. This is commonly found in severe peripheral venous disease. Options B and C are found in peripheral ARTERIAL disease.

True or False: Peripheral arterial disease leads to a decrease in rich oxygenated blood being delivered to the lower extremities, which leads to ischemia and necrosis of skin tissue. A. True B. False

A. True

A patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular edges. The wound base is red. Wound drainage is also present. What type of ulcer is this based on the scenario's description? A. venous ulcer B. arterial ulcer C. diabetic ulcer

A. Venous ulcer The answer is A. These findings are associated with a venous ulcer.

After providing a client with teaching regarding a new diagnosis of peripheral artery disease (PAD), which client statement indicates to the nurse an accurate understanding of the information presented? Select all that apply. A. "I should check the water temperature by placing my foot in the bath first." B. "I have contacted a friend and we walk at least 15 to 30 minutes a day." C. "I will elevate my legs as much as possible to reduce swelling around my ankles." D. "I will only take my cholesterol lowering medication every other day in the afternoon." E. "With this problem, I may not have to shave my legs as often."

B. "I have contacted a friend and we walk at least 15 to 30 minutes a day." Moderate physical activity is encouraged for clients with PAD as it will help to improve peripheral circulation. E. "With this problem, I may not have to shave my legs as often." This client statement reflects an accurate understanding of PAD. Due to decreased peripheral perfusion, hair loss in the extremities may result leading to a decreased need for shaving of the legs.

You're providing discharge teaching to a patient with peripheral arterial disease. Which statement by the patient requires you to re-educate the patient? A. "It is important I quit smoking." B. "To prevent my feet and legs from getting too cold at night, I will use a heating pad. C. "A walking program would be beneficial in treatment of my PAD." C. "I will avoid wearing tight socks or shoes."

B. "To prevent my feet and legs from getting too cold at night, I will use a heating pad. The answer is B. The patient should try to prevent the feet and legs from getting too cold because this causes vasoconstriction, which impedes blood flow further. Therefore, they should dress warmly with LOOSE layers. However, they should AVOID using heating pads because of the reduce of sensation from compromised blood flow. A walking program is a great way to prevent intermittent claudication, lower the cholesterol, and improve oxygen levels in the blood....which are all great ways of treating PAD.

A patient has severe peripheral venous disease. What important information below will the nurse provide to the patient about how to alleviate signs and symptoms associated with the disease? Select all that apply: A. Elevate the lower extremities below heart level frequently B. Application of compression stockings C. Limit long periods of standing and sitting D. Use the knee-flexed position while lying in bed

B. Application of compression stockings C. Limit long periods of standing and sitting The answers are B and C. The patient with peripheral VENOUS disease should elevate the lower extremities ABOVE heart level (this helps return blood to the heart and decrease swelling/pain), avoid crossing the legs (or the knee-flexed position) because this impedes blood flow, and limit long periods of standing and sitting (this limits blood return to the heart and increases swelling). In addition, the application of compression stockings is very beneficial in peripheral venous disease because it helps blood return to the heart and prevents the stasis of blood in the lower extremities.

Your patient has returned from a peripheral artery bypass for the treatment of peripheral arterial disease. The nurse will make it PRIORITY to? A. Assess the surgical site for excessive drainage B. Assess and grade lower extremity pulses bilaterally C. Apply compression stockings D. Elevate the lower extremity above heart level

B. Assess and grade lower extremity pulses bilaterally The answer is B. A peripheral artery bypass is performed to treat severe cases of PAD. The surgeon will "bypass" the blockage in the lower extremity and have blood flow re-routed around the blockage. This will provide blood flow back to the lower extremity. It is PRIORITY that the nurse assesses and grades the lower extremity pulses bilaterally frequently. If the pulses diminish or become absent the nurse should notify the physician immediately.

The nurse is caring for a client with peripheral vascular disease​ (PVD). Which nursing intervention should the nurse​ implement? (Select all that​ apply.) A. Keep legs in dependent position during sleep. B. Assess peripheral pulses. C. Keep lower extremities warm. D. Encourage exercise. E. Encourage frequent position change.

B. Assess peripheral pulses. C. Keep lower extremities warm. D. Encourage exercise. E. Encourage frequent position change. To evaluate and promote tissue perfusion in the client with​ PVD, the nurse should assess peripheral pulses to ensure adequate​ perfusion, keep lower extremities warm to prevent vasoconstriction associated with cold​ temperatures, encourage exercise to increase circulation to lower​ extremities, and encourage frequent position changes to avoid a decrease in circulation to the lower extremities. The nurse should elevate the legs during sleep and rest. Elevation promotes venous return from the​ extremity, increasing circulation and relieving pain.

True or False: Peripheral venous disease can occur due to narrowing of the valves in the veins of the lower extremities. A. True B. False

B. False The answer is FALSE. Peripheral venous disease can occur due to overstretched valves of the veins (NOT narrowed) in the lower extremities. In addition, it can occur when the veins become damaged.

The nurse is performing a nursing assessment for a client with peripheral vascular disease​ (PVD). Which data should the nurse collect during the health​ history? (Select all that​ apply.) A. Presence of skin discoloration B. History of coronary artery disease C. Current medications D. Current diet E. Presence of pain

B. History of coronary artery disease C. Current medications D. Current diet E. Presence of pain During the health history portion of the nursing assessment for the client with​ PVD, the nurse will assess client history of coronary artery disease​ (CAD), current medications and​ diet, and any complaints of pain. Presence of skin discoloration would be assessed during the physical exam portion of the nursing assessment.

The MOST common cause of peripheral arterial disease is? A. Diabetes B. Deep vein thrombosis C. Atherosclerosis D. Pregnancy

C. Atherosclerosis The answer is C. Atherosclerosis is the most common cause of PAD (peripheral arterial disease). This is the collection of fatty plaques on the artery wall. This blocks blood flow.

our patient reports experiencing dull and achy sensations in the lower extremities. You note that the lower extremities have edema and brownish pigmentation. Pulses are present bilaterally and the extremities feel warm to the touch. To help alleviate the patient's symptoms, the nurse will position the lower extremities in the? A. Dependent position B. Horizontal position C. Elevated position above heart level D. Knee-flexed position

C. Elevated position above heart level The answer is C. Based on the signs and symptoms in the scenario above, the patient is experiencing peripheral VENOUS disease. The blood is stagnant (or static) in the lower extremities and can't flow back to the heart. Therefore, the patient is experiencing dull and achy sensations along with edema and brownish pigmentation. The nurse should place the patient's lower extremities in the elevated position above the heart to help facilitate blood return to the heart and alleviate the pain.

A patient has an arterial ulcer on the lower extremity. What risk factors for peripheral arterial disease are in the patient's health history? Select all that apply: A. Pregnancy B. Being Female C. High Cholesterol D. Diabetes Mellitus E. Uncontrolled hypertension F. Varicose veins G. Smoking

C. High Cholesterol D. Diabetes Mellitus E. Uncontrolled hypertension G. Smoking The answers are C, D, E, and G. High cholesterol, diabetes mellitus, uncontrolled hypertension, and smoking are risk factors for peripheral arterial disease (PAD). Pregnancy, being female, varicose veins are risk factors for peripheral venous disease.

Your patient is diagnosed with Buerger's Disease (thromboangiitis obliterans). The nurse will make it priority to educate the patient about implementing? A. Low fat diet B. Blood glucose control C. Smoking cessation D. Blood pressure control

C. Smoking cessation The answer is C. The most common cause of Buerger's Disease (thromboangiities obliterans) is tobacco usage (smoking). Buerger's Disease occurs when the blood vessels of the hands and feet become inflamed and clots form. The clots will block blood flow. The nurse should make it priority to educate the patient on smoking cessation.

The nurse is teaching a client about the endarterectomy she will undergo soon for peripheral atherosclerosis. Which statement should the nurse include in the​ teaching? A. An endarterectomy is the first choice of treatment for peripheral atherosclerosis. B. An endarterectomy allows for the placement of a bypass graft. C. The purpose of an endarterectomy is to remove plaque from the artery. D. The purpose of an endarterectomy is to vaporize the occluding material.

C. The purpose of an endarterectomy is to remove plaque from the artery. An endarterectomy is performed to remove plaque from an occluded artery. Laser or thermal angioplasty is used to vaporize occluding material. Surgery is not a first​ choice, but is performed if symptoms are​ progressive, severe, or disabling. Bypass grafts are placed during bypass graft surgery.

Cancer can cause changes in what component of Virchow's triad? A. Blood coagulability B. Vessel walls C. Blood flow D. Blood viscosity

Correct Answer: A. Blood coagulability Charles Emile Troisier later recognized the further association of other abdominal cancers as well as testicular cancer with the presence of Virchow's node. Virchow sought to explain the causation of pulmonary thromboembolism and theorized that pulmonary arterial embolus arises from peripheral/distant thrombosis.

A nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing an aortoiliac bypass graft. The affected leg is warm, and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. The nurse interprets that the neurovascular status is: A. Normal because of the increased blood flow through the leg. B. Slightly deteriorating and should be monitored for another hour. C. Moderately impaired, and the surgeon should be called. D. Adequate from the arterial approach, but venous complications are arising.

Correct Answer: A. Normal because of the increased blood flow through the leg. An expected outcome of surgery is warmth, redness, and edema in the surgical extremity because of increased blood flow. Aortofemoral bypass surgery is a procedure utilized commonly for the treatment of aortoiliac occlusive disease, sometimes referred to as Leriche syndrome. Aortoiliac occlusive disease can contribute to lower extremity ischemic symptoms necessitating intervention.

A nurse has the order to begin administering warfarin sodium (Coumadin) to a client. While implementing this order, the nurse ensures that which of the following medications is available on the nursing unit as the antidote for Coumadin? A. Vitamin K B. Aminocaproic acid C. Potassium chloride D. Protamine sulfate

Correct Answer: A. Vitamin K The antidote to warfarin (Coumadin) is Vitamin K and should be readily available for use if excessive bleeding or hemorrhage should occur. When managing warfarin toxicity, the initial step would be to discontinue warfarin and then administer vitamin K (phytonadione). The vitamin K may administration can be either via the oral, intravenous, or subcutaneous route. However, the initial administration of oral vitamin K is often preferable in patients without major bleeding or extremely elevated INR.

A nurse is caring for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse would inspect the surgical site most closely for signs of: A. Thrombosis and infection B. Bleeding and infection C. Bleeding and wound dehiscence. D. Wound dehiscence and evisceration.

Correct Answer: B. Bleeding and infection After inferior vena cava insertion, the nurse inspects the surgical site for bleeding and signs and symptoms of infection. Otherwise, care is the same as for any post-op client. During the vascular access for IVC filter insertion, bleeding and thrombosis are the most common complications. Other complications that can occur during this time include filter tilt (angulation of more than 15 degrees along the longitudinal axis of IVC), filter migration (change in position of the filter by more than 2 cm) or operator error (filter placement in the inaccurate location or incorrect orientation); these can result in a difficult to retrieve as well as an ineffective IVC filter.

A client who has been receiving heparin therapy also is started on warfarin sodium (coumadin). The client asks the nurse why both medications are being administered. In formulating a response, the nurse incorporates the understanding that warfarin sodium: A. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this to exhibit an anticoagulant effect. B. Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for this medication to exert an anticoagulation effect. C. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for it to begin. D. Has the same mechanism action of heparin, and the crossover time is needed for the serum level of warfarin sodium to be therapeutic.

Correct Answer: B. Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for this medication to exert an anticoagulation effect. Warfarin sodium works in the liver and inhibits synthesis of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4 days before the therapeutic effect of warfarin is exhibited. Heparin is generally continued for seven to ten days. During this time warfarin is generally begun, and it is important to continue the patient on warfarin for five to seven days while the patient is receiving intravenous heparin therapy. After stopping heparin, oral anticoagulation with warfarin should be continued for six weeks.

In preparation for the discharge of a client with arterial insufficiency and Raynaud's disease, client teaching instructions should include: A. Walking several times each day as an exercise program. B. Keeping the heat up so that the environment is warm. C. Wearing a TED hose during the day. D. Using hydrotherapy for increasing oxygenation.

Correct Answer: B. Keeping the heat up so that the environment is warm. The client's instructions should include keeping the environment warm to prevent vasoconstriction. In response to cold temperatures, the body adapts by restricting blood flow to the skin. This is done as a thermoregulatory mechanism to prevent further loss of body heat and to sustain the core body temperature. In Raynaud's phenomenon, blood-flow restriction occurs during cold temperatures and emotional stress.

A 24-year old man seeks medical attention for complaints of claudication in the arch of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse would next assess the client for: A. Familial tendency toward peripheral vascular disease. B. Smoking history. C. Recent exposures to allergens. D. History of insect bites.

Correct Answer: B. Smoking history The mixture of arterial and venous manifestations (claudication and phlebitis, respectively) in the young male client suggests Buerger's disease. This is an uncommon disorder characterized by inflammation and thrombosis of smaller arteries and veins. This disorder typically is found in young adult males who smoke. The cause is not known precisely but is suspected to have an autoimmune component.

Which technique is considered the gold standard for diagnosing DVT? A. Ultrasound imaging B. Venography C. MRI D. Doppler flow study

Correct Answer: B. Venography Proximal leg vein ultrasound, which when positive, indicates that the patient should be treated as having a DVT. If a patient scores 2 or above, either a proximal leg vein ultrasound scan should be done within 4 hours, and if the result is negative, a D-dimer test should be done. If imaging is not possible within 4 hours, a D-dimer test should be undertaken, and an interim 24-hour dose of a parenteral anticoagulant should be given. A proximal leg vein ultrasound scan should be carried out within 24 hours of being requested.

A 2-gram sodium diet is prescribed for a client with severe hypertension. The client does not like the diet, and the nurse hears the client's request that the spouse "Bring in some good home-cooked food." It would be most effective for the nurse to plan to: A. Call in the dietician for client teaching. B. Wait for the client's family and discuss the diet with the client and family. C. Tell the client that the use of salt is forbidden, because it will raise BP. D. Catch the family members before they go into the client's room and tell them about the diet.

Correct Answer: B. Wait for the client's family and discuss the diet with the client and family Clients' families should be included in dietary teaching; families provide the support that promotes adherence. Discuss the necessity for decreased caloric intake and limited intake of fats, salt, and sugar as indicated. Excessive salt intake expands the intravascular fluid volume and may damage kidneys, which can further aggravate hypertension.

Varicose veins can cause changes in what component of Virchow's triad? A. Blood coagulability B. Vessel walls C. Blood flow D. Blood viscosity

Correct Answer: C. Blood flow Venous stasis is more likely to occur in patients with atrial fibrillation, valvular heart disease: prolonged immobility such as bedridden patients or prolonged travel, surgery, and trauma. Exposure to cell proteins triggers anticoagulant pathways on the surface of endothelial cells. The thinking is that as blood flow slows through vascular beds, flow reduces, and the natural anticoagulant properties from interaction with surface proteins are affected, resulting in thrombi production. Option A: Hypercoagulability can occur due to a variety of clinical statuses such as pregnancy, use of oral contraceptive medications, cancer, chemotherapy drugs, and inherited thrombophilias. Thrombophilias can include disease states such as protein C deficiency, protein S deficiency, antithrombin deficiency, hyperhomocysteinemia and homocystinuria, and antiphospholipid syndrome. Option B: Damage to the endothelial wall of a vessel alters the dynamics of blood flow. Endothelial disturbance can result from insults such as smoking, chronically elevated blood pressure, and atherosclerotic disease secondary to hyperlipidemia. When an insult to the wall occurs, flow disruption or "turbulence" occurs. Option D: Turbulent flow within a vessel occurs when the rate of blood flow becomes too rapid, or blood flow passes over an affected surface; this creates disordered flow and eddy currents, increasing the friction of flow within a vessel.

Which of the following characteristics is typical of the pain associated with DVT? A. Dull ache B. No pain C. Sudden onset D. Tingling

Correct Answer: C. Sudden onset DVT is associated with deep leg pain of sudden onset, which occurs secondary to the occlusion. A deep-vein thrombosis (DVT) is a blood clot that forms within the deep veins, usually of the leg, but can occur in the veins of the arms and the mesenteric and cerebral veins. Deep-vein thrombosis is a common and important disease. Option A: A dull ache is more commonly associated with varicose veins. Deep-vein thrombosis and pulmonary emboli are common and often "silent" and thus go undiagnosed or are only picked up at autopsy. Therefore, the incidence and prevalence are often underestimated. Option C: If the thrombus is large enough, it will cause pain. DVT is part of the venous thromboembolism disorders which represent the third most common cause of death from cardiovascular disease after heart attacks and stroke. Even in patients who do not get pulmonary emboli, recurrent thrombosis and "post-thrombotic syndrome" are major cause of morbidity. Option D: A tingling sensation is associated with an alteration in arterial blood flow. The triggers of venous thrombosis are frequently multifactorial, with the different parts of the triad of Virchow contributing in varying degrees in each patient, but all result in early thrombus interaction with the endothelium. This then stimulates local cytokine production and causes leukocyte adhesion to the endothelium, both of which promote venous thrombosis.

Cholesterol, frequently discussed in relation to atherosclerosis, is a substance that: A. May be controlled by eliminating food sources. B. Is found in many foods, both plant and animal sources. C. All persons would be better off without because it causes the disease process. D. Circulates in the blood, the level of which usually decreases when unsaturated fats are substituted for saturated fats.

Correct Answer: D. Circulates in the blood, the level of which usually decreases when unsaturated fats are substituted for saturated fats. Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats. Cholesterol is a lipophilic molecule that is essential for human life. It has many roles that contribute to normally functioning cells. For example, cholesterol is an important component of the cell membrane. It contributes to the structural makeup of the membrane as well as modulates its fluidity.

Intravenous heparin therapy is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available in the nursing unit? A. Vitamin K B. Aminocaproic acid C. Potassium chloride D. Protamine sulfate

Correct Answer: D. Protamine sulfate The antidote to heparin is protamine sulfate and should be readily available for use if excessive bleeding or hemorrhage should occur. Protamine is a medication used to reverse and neutralize the anticoagulant effects of heparin. Protamine is the specific antagonist that neutralizes heparin-induced anticoagulation. When appropriately dosed, this neutralization reduces the risk of postoperative bleeding.

Your patient has severe peripheral arterial disease. When the lower extremities are elevated you would expect them to appear _______________ and, when they are in the dependent position you would expect them to appear _________________. Fill in the blanks: A. cyanotic; rubor B. rubor; pallor C. cyanotic, pallor D. pallor; rubor

D. pallor; rubor The answer is D. In severe PAD, if the lower extremities are elevated they will turn pale (pallor). However, if they are in the dependent position (dangling) they will appear rubor (red and warm...this occurs due to inflammation of the vessels).

A nurse is examining a client diagnosed with peripheral vascular disease who has an ulcer on the great right toe. Which additional assessment finding should the nurse expect? (Select all that apply) A. The toenails are thickened B. The extremity is cool to touch C. There is an absence of hair on the legs D. There is brown pigmentation of the lower extremity E. There is pitting edema in the lower extremity

Wounds on toes, absence of hair on the legs, cool extremities, and thick toenails are all features of arterial problems. Venous problems are characterized by brown pigmentation of the skin of the lower extremity and edema.

A nurse is teaching a client about aspirin for peripheral vascular disease​ (PVD). Which client statement indicates that teaching has been​ successful?​ A. "This medication will prevent me from developing a blood​ clot."​ B. "This medication will thin out my blood so it flows​ easier." ​C. "This medication will open my arteries and increase blood flow to my​ legs."​ D. "This medication will help decrease the plaque in my​ arteries."

​A. "This medication will prevent me from developing a blood​ clot." Aspirin, an​ antiplatelet, is prescribed in PVD to prevent clot formation. Aspirin does not​ vasodilate, decrease​ viscosity, or help decrease plaque in the arteries. Pentoxifylline​ (Trental) decreases blood viscosity and Cilostazol​ (Pletal) decreases blood viscosity in addition to preventing further clots.