Med-Surg Chapter 37

The nurse is assessing a patient with a saccular aneurysm. The nurse recalls what characteristic of this type of aneurysm?

A saccular aneurysm is pouchlike and has a narrow neck that connects the bulge to one side of the arterial wall. A fusiform aneurysm is circumferential and relatively uniform in shape. False aneurysms occur due to peripheral artery bypass graft surgery. A true aneurysm involves formation of the aneurysm with at least one vessel layer still intact.

The nurse is caring for a patient with Buerger's disease and expects which clinical manifestation?

Buerger's disease is characterized by inflammation of the arteries and veins of the upper and lower extremities. This causes pain in the legs and feet with exercise. Sensitivity to cold and paresthesias is also often seen with this condition. Buerger's disease is not associated with back pain when lying flat or vasodilation resulting in reddening of the lower legs or feet when elevated. Buerger's disease is not directly associated with chest pain.

A patient is hospitalized with a suspected abdominal aortic aneurysm. Which test is used to map the entire aortic system?

Contrast media, which gives contrast images to map the entire aortic system, is used in angiography. An x-ray study shows calcification within the aortic wall. An ultrasound study is used to monitor the aneurysm size. An electrocardiogram is used to assess the function of the aortic valve.

The nurse reviews the treatments for lower extremity peripheral artery disease (PAD). Which therapy involves percutaneous transluminal angioplasty (PTA) and cold therapy?

Cryoplasty involves percutaneous transluminal angioplasty and cold therapy that use a specialized balloon filled with liquid nitrous oxide. Expansion of gas causes cooling that prevents restenosis. A stent is an expandable metallic device that helps keep an artery open. Atherectomy is the process of removing obstructing plaque. Endothelial progenitor cell therapy is used to stimulate blood vessel growth.

The nurse administers dalteparin to a patient as prescribed. During a follow-up visit, the patient reports bleeding from the gums and nose, stomach and chest pain, shortness of breath, and blood in the urine. The nurse should prepare to administer what medication?

Dalteparin is an anticoagulant that prevents the risk of venous thromboembolism; side effects include bleeding from the gums and nose, stomach and chest pain, shortness of breath, and blood in urine. Protamine reverses the anticoagulant effects of dalteparin. Bosentan, nifedipine, and metaprolol do not act as antidotes for dalteparin toxicity.

A patient receives a prescription for 60 mg enoxaparin. Which injection site should the nurse use to administer the medication safely?

Enoxaparin is a low-molecular-weight heparin that is given as a subcutaneous injection. The preferred injection sites for this medication are the right and left anterolateral abdominal wall. All subcutaneous injections should be given away from scars, lesions, or moles. The thigh and flank are not appropriate sites for administering enoxaparin because of poorer absorption of the medication in the thigh or flank, and it should not be given intramuscularly in the deltoid because of risk of hematoma development.

A patient has a blood pressure of 180/98 mm Hg after aortic aneurysm surgery. Which drug will the nurse administer to reduce hypertension in this patient?

Hydralazine is an antihypertensive drug that reduces hypertension. It prevents the leakage of blood or rupture at the suture lines after aortic aneurysm surgery. Protamine is used as an antidote for thrombin inhibitor. Bivalirudin is a hirudin derivative. It is used as an anticoagulant. Gentamicin is used to treat bacterial infections

A patient is admitted to the emergency department with suspected aortic dissection. The nurse suspects that the aortic arch is involved based on what assessment finding?

If the aortic arch is involved, the patient may exhibit neurologic deficits. These include altered level of consciousness, weakened or absent carotid and temporal pulses, and dizziness or syncope. Abdominal aortic aneurysm (AAA) symptoms include blue toe syndrome (patching mottling of the feet and toes in the presence of palpable pedal pulses), intermittent claudication, and epigastric discomfort.

A patient develops postthrombotic syndrome. The nurse assesses lipodermatosclerosis, which has what hallmark characteristic?

In lipodermatosclerosis, the skin on the lower leg is scarred and leathery, with brown discoloration. A swollen, blue, painful leg, or phlegmasia cerulea dolens, is a rare complication that may develop in a patient in the advanced stages of cancer. The presence of cordlike veins is associated with superficial vein thrombosis.

A patient is diagnosed with coronary artery disease (CAD), which increases the patient's risk of developing several medical conditions. The nurse recognizes that it essential to provide the patient with education about which condition that requires immediate emergency treatment?

Risk factors for aortic aneurysm include CAD. Patients should be instructed to seek help immediately if an aneurysm is suspected. If rupture occurs into the thoracic or abdominal cavity, patients can die from massive haemorrhage. Coronary artery disease doesn't reduce bone density, so the patient is not likely to develop osteoporosis. Coronary artery disease does not reduce the release of sex hormones, so it unlikely that the patient will have erectile dysfunction. Coronary artery disease is not associated with a risk of HIV infection.

The nurse reviews a patient's medication profile and identifies that which medication may cause thrombocytopenia?

Rivaroxaban acts as an anticoagulant by inhibiting the clotting factor Xa. Rivaroxaban may decrease the platelet count and may cause thrombocytopenia. Diclofenac is a nonsteroidal antiinflammatory agent (NSAID) that reduces pain. Corticosteroids, such as prednisone, increase the risk of thrombus formation in patients and may not cause thrombocytopenia. Metoprolol can cause depression and erectile dysfunction.

The nurse is providing postoperative care to a patient who underwent aortic surgery. The nurse anticipates that what medication will be given to prevent complications?

Severe hypertension should be prevented in the patient after an aortic surgery because it may cause stress on the arterial anastomoses. Furosemide should be administered to the patient to maintain blood pressure. Diclofenac is administered to reduce pain and inflammation. Tamoxifen is used to treat breast cancer. Clopidogrel is administered to prevent venous thromboembolism.

A patient with Raynaud's phenomenon is being discharged from the hospital. Which instructions should the nurse include in the patient's discharge teaching plan? Select all that apply.

Smoking or use of any tobacco products, emotional stress, and drugs containing pseudoephedrine often trigger an attack of Raynaud's phenomenon. Tight clothing should not be worn because it can reduce circulation. During an attack fingertips should be immersed in warm water to help decrease vasospasm.

Which treatment may help prevent amputation in patients with critical limb ischemia?

Spinal cord stimulation helps in managing pain and prevents the need for amputation in patients with critical limb ischemia. Nifedipine is used to reduce severity of vasospastic attacks. Pseudoephedrine should not be given to patients with critical limb ischemia because it may produce vasoconstrictive effect. Oxygen supply is recommended to treat myocardial ischemia.

Which ankle-brachial index (ABI) value indicates noncompressible arteries?

The ABI is a screening tool for peripheral artery disease. It is performed by using a hand-held Doppler. The ABI is calculated by dividing the ankle systolic blood pressure by the higher of the left and right brachial systolic blood pressure. An ankle-brachial index of more than 1.40 indicates noncompressible arteries. An ankle-brachial index between 0.91 and 0.99 indicates borderline ABI. An ankle-brachial index between 1.00 and 1.40 is a normal ABI.

It is appropriate for the registered nurse (RN) to delegate which intervention to a licensed practical nurse (LPN) when providing care to a patient with venous thromboembolism?

The LPN can administer prescribed subcutaneous anticoagulants to the patient because it is within his or her scope of profession. The RN, not the LPN, should monitor for adverse effects of anticoagulant use, provide instructions to the patient about the use of pressure to stop bleeding, and teach the patient about the use of elastic compression stockings during a hospital discharge.

A patient presents with symptoms of venous thromboembolism (VTE) in the calf. The nurse expects that what study will be performed, recalling that it is the most widely used test to diagnose VTE?

The duplex ultrasound is the most widely used test to diagnose VTE. Contrast venography rarely is used now. Magnetic resonance venography is less accurate for calf veins than pelvic and proximal veins. Computed tomography venography may be used but is invasive and much more expensive than the duplex ultrasound.

A patient with chronic venous insufficiency (CVI) presents to the hospital with a large and infected leg venous ulcer. In which order should the nurse perform interventions to provide the most effective care to the patient?

The nurse should assess the patient before determining any treatment plan. A wound culture should be obtained. Antibiotic therapy should be guided by wound culture results. Routine evaluations are desirable to check the efficiency of the therapy. Other treatments are recommended if the ulcer does not respond to standard therapy after 4 to 6 weeks.

After assessing a patient, the nurse identifies that the patient is in the initial stage of Raynaud's disorder. The determination was made based on what assessment finding?

The vasospasm-induced color changes (from white to blue to red) of fingers, toes, ears, and nose are the usual characteristics of Raynaud's disorder. Decreased perfusion leads to pallor (white), followed by cyanotic (bluish purple) digits that further turn red when blood flow is restored. In the later phases of the disease, the patient may complain about numbness and coldness along with throbbing, tingling, and swelling. Chronic ischemic pain and ulceration may indicate peripheral arterial disease, whereas hypertension, hyperglycemia, and inflamed arteries may indicate one or more cardiovascular disorders. Further diagnostic tests are desirable to confirm the diagnosis.

A patient's diagnostic reports show calcification within the aortic wall and abnormal widening of the thoracic wall. The nurse expects what clinical manifestation? Select all that apply.

Back pain, epigastric discomfort, and altered bowel elimination are associated with aortic aneurysms. Bluish fingers and toes, pallor, pain, and numbness are symptoms of Raynaud's phenomenon. Decreased urine output is associated with aneurysm rupture

The nurse reviews the medication profile of a patient and identifies that which type of medication predisposes the patient to thrombus formation?

Corticosteroids can inhibit the fibrinolytic activity of the blood and increase the risk of thrombus formation. Antibiotics do not inhibit the fibrinolytic activity of the blood. β-adrenergic blockers are used to treat aortic dissection; side effects include dizziness, depression, fatigue, and erectile dysfunction. Nonsteroidal antiinflammatory drugs (NSAIDs) are used to reduce inflammation and may cause gastric bleeding.

A patient with diabetes is being discharged after distal peripheral bypass surgery below the knee. What should the nurse include in the patient's discharge instructions? Select all that apply.

A patient with diabetes is being discharged after distal peripheral bypass surgery below the knee. What should the nurse include in the patient's discharge instructions? Select all that apply.

A patient with lower extremity peripheral artery disease (PAD) undergoes a balloon angioplasty with stent placement. The nurse recalls that the balloon and the stent may be coated with what medication to reduce restenosis?

A stent is an expandable metallic device that helps in keeping the artery open. The stent should be covered with paclitaxel. Paclitaxel limits the amount of new tissue growth in the stent and reduces the risk of restenosis. Bosentan is used to treat critical ischemia. Doxycycline is used to treat infection. Amphetamines should not be administered because they may cause a vasoconstrictive effect.

The nurse is examining a female patient who experiences leg edema and pain. What history findings indicate that the patient is at a high risk for venous thromboembolism (VTE)? Select all that apply.

A woman who uses an estrogen-based oral contraceptive and tobacco is at high risk for VTE. These compounds may cause hypercoagulability and may activate the intrinsic coagulation pathway that leads to deep vein thrombosis and pulmonary embolism. The risk increases if the patient has a family history of VTE because the patient may carry the mutated genes responsible for the disease. High altitude causes hypercoagulability of blood. Some medications, such as corticosteroids, may stimulate thrombus formation, but aspirin has shown no such tendency.

An abdominal x-ray report of an obese patient indicates a pulsatile mass in the periumbilical area. Further tests confirm a diagnosis of abdominal aortic aneurysm (AAA). The nurse recognizes that aneurysms in the early phase are often difficult to diagnose for what reasons? Select all that apply.

Abdominal aortic aneurysms (AAAs) are often asymptomatic and may mimic the pain associated with abdominal and back disorders. Detection of this disorder is more difficult in obese patients until the aorta becomes very large in size because it can be hidden under thick layers of fat. The aneurysm may be identified during routine examinations of an unrelated problem. These are usually diagnosed when the patient undergoes evaluation for an unrelated problem. AAA can be easily detected through test x-rays, ultrasounds, and CT scans.

The nurse provides postoperative care to a patient who has undergone an endovascular graft procedure. The nurse identifies that which condition may result in graft thrombosis?

Adequate blood pressure is important for maintaining graft patency. Prolonged low blood pressure hampers the blood circulation and may increase the risk of graft thrombosis. Diaphoresis and periumbilical pain are symptoms of aneurysm rupture. An elevated white blood cell count indicates infection.

What is an appropriate nursing intervention for a patient following vein ligation surgery?

After vein ligation surgery, the nurse should ensure that the patient keeps his or her legs elevated at 15 degrees to reduce edema. Elastic compression stockings should be removed every 8 hours for short periods and reapplied. Some bruising and discoloration are normal. The patient should be encouraged to breathe deeply to promote venous return.

A patient is scheduled for aortic surgery. The nurse provides education related to postoperative management of the gastrointestinal system. What should the nurse include in the teaching? Select all that apply.

An NG may be placed during surgery and attached to low, intermittent suction. Early ambulation assists with the return of bowel function. While the NG is in place, the patient will be NPO but can have ice chips or lozenges. A postoperative ileus rarely lasts beyond the fourth postoperative day. The passing of flatus indicates returning bowel function.

The nurse is assessing a patient with patchy mottling of the feet and toes. The nurse recognizes that the assessment finding may be indicative of what?

An abdominal aortic aneurysm may cause embolism in the small blood vessels, causing patchy mottling of the feet and toes, called blue toe syndrome. Nephrotic syndrome may cause hypercoagulability of blood. Deep vein thrombosis may cause thrombus formation in the deep veins. Peripheral artery disease may cause compartment syndrome after surgery.

A patient has loss of hair on the legs and the feet, extremities cold to the touch, and brittle nails. The ankle-brachial index (ABI) is 0.41 and the laboratory report indicates decreased Doppler pressures. What should the nurse interpret from the assessment findings?

An absence of hair on the legs and feet, thickened, brittle nails, and cool feet indicates PAD. Long-term use of heparin causes osteoporosis as a side effect. Bluish fingers and toes, pallor, pain, and numbness are symptoms of Raynaud's phenomenon. The main difference between arterial and venous disease is the difference in skin temperature; in PAD, the skin temperature is cool, whereas, in venous disease, the temperature is warm.

The nurse reviews the treatment plan for a patient with symptomatic peripheral artery disease (PAD). The nurse expects to find which medications listed on the plan? Select all that apply.

Angiotensin-converting enzyme (ACE) inhibitors (e.g., ramipril) are used to control hypertension. Statins (e.g., simvastatin) are used for lipid management. Aspirin is used as an antiplatelet agent. Iloprost is used to manage pain associated with thromoboangiitis obliterans. Nifedipine, a calcium channel blocker, is first-line drug therapy for Raynaud's phenomenon. Warfarin is an anticoagulant and is not recommended for use in PAD patients. Argatroban is a synthetic thrombin inhibitor and used in patients at risk for or with heparin-induced thrombocytopenia (HIT).

The nurse is caring for a male patient after aortic surgery. The nurse should instruct the patient to report which common complication that is associated with this type of surgery?

Aortic surgery may compromise the blood circulation to the male genital organs and cause sexual dysfunction in the male patient. Prolonged treatment with heparin causes osteoporosis in both male and female patients. Rheumatoid arthritis may cause Raynaud's phenomenon in both male and female patients. An elevated C-reactive protein level results in atherosclerotic diseases such as peripheral artery disease in both male and female patients.

The nurse assesses an absence of bowel sounds in a patient who underwent aortic surgery. The patient reports severe abdominal pain. What the priority nursing action?

Bowel infarction may result from restricted blood flow to the bowel due to occlusion of the mesenteric arteries. Therefore, immediate reoperation is necessary to restore the blood flow. Metoprolol is recommended to the patient who has a history of cardiovascular disease. It is administered to the patient before surgery to reduce morbidity and mortality. Laser therapy will not be beneficial to the patient with a bowel infarction. Sodium nitroprusside is administered to the patient after surgery to prevent hypertension.

The nurse recognizes that which interventions may benefit a patient with Buerger's disease? Select all that apply.

Buerger's disease is an inflammation characterized by thrombosis in small and medium-sized blood vessels. Marijuana use will worsen Buerger's disease symptoms. Calcium channel blockers may be prescribed to decrease pain. Administering analgesic medications will help manage the ischemic pain. The patient should avoid cold room temperatures because he or she may have cold sensitivity. The use of nicotine replacement products is contraindicated in Buerger's disease.

The nurse provides care to a patient diagnosed with thromboangiitis obliterans (Buerger's disease). What is the primary treatment for the disease?

Buerger's disease occurs most commonly in young adults with a long history of tobacco and/or marijuana use. The primary treatment is complete cessation of tobacco and marijuana use. The patient can be prescribed IV iloprost to improve rest pain, promote healing of ulcerations, and decrease the need for amputation. Bypass surgery is typically not an option because of the involvement of smaller, distal vessels. Cilostazol may be tried to decrease pain; it will not stop disease progression.

The nurse provides postoperative care to a patient who underwent peripheral artery bypass surgery. Thirty minutes after the initial assessment, the nurse reassesses the patient and detects a change in the Doppler sound over a pulse. What action should the nurse take?

Changes in Doppler sounds immediately after peripheral artery bypass surgery indicate complications. Therefore, the nurse should notify the primary health care provider to provide immediate treatment. Oral anticoagulants are useful for preventing acute arterial ischemic episodes. The nurse should not measure ankle-brachial index after peripheral artery bypass surgery because it may cause graft thrombosis. Surgical revascularization is the best option for the patient who has trauma.

The nurse is caring for a hospitalized patient who is receiving anticoagulant therapy for venous thromboembolism (VTE). Which interventions should the nurse perform for this patient? Select all that apply.

Nursing interventions for the patient taking anticoagulant therapy include evaluation of platelet count for signs of heparin-induced thrombocytopenia. The nurse should preferably use a small-gauge needle for venipuncture. The nurse should humidify O2 source if supplemental O2 is prescribed; this will decrease the risk of nosebleed. Restraints should be avoided if possible, but if they are needed, the nurse should use soft, padded restraints. Manual pressure should be applied for 10 minutes or longer at venipuncture sites.

The nurse anticipates a prescription for which treatment for a patient who has undergone distal peripheral bypass surgery using synthetic graft material?

Dual antiplatelet therapy is recommended for one year after a distal peripheral bypass surgery using a synthetic graft material to prevent clot formation. After 1 year, single antiplatelet therapy is recommended for the lifetime. Furosemide is a diuretic drug and is used to reduce hypertension. Propranolol is a β-adrenergic blocking drug and is used to reduce the growth rate of an aneurysm rupture. Nitroprusside is an antihypertensive drug, and it prevents severe hypertension.

A postoperative patient asks the nurse why daily enoxaparin has been prescribed. How should the nurse respond?

Enoxaparin is an anticoagulant that is used to prevent deep vein thromboses (DVTs) postoperatively. Enoxaparin does not prevent breathing problems or pneumonia. Enoxaparin does not have hypotensive effects. Enoxaparin is not a medication used to treat pain.

The nurse provides teaching to a patient with Raynaud's phenomenon about how to prevent recurrent episodes. The nurse should instruct the patient to avoid what? Select all that apply

Exposure to cold (not heat), emotional upsets, tobacco use, and caffeine often bring on symptoms of Raynaud's phenomenon. Wearing gloves often is recommended to protect the hands from exposure to cold.

Which condition should the nurse check in the patient's history before administering cilostazol?

Cilostazol inhibits phosphodiesterase III and worsens the symptoms of heart failure. Cilostazol use is safe in diabetic patients. Cilostazol is used to treat Buerger's disease. Intermittent claudication in a patient is not a contraindication to cilostazol use.

A patient is diagnosed with intermittent claudication. The nurse expects the patient's treatment plan to include what medication?

Cilostazol is a first-line drug that reduces intermittent claudication by inhibiting platelet aggregation and increasing vasodilation in the patient who does not respond to exercise therapy. Iloprost is used to treat critical limb ischemia. Ibuprofen is a nonsteroidal antiinflammatory drug that reduces inflammation. Omeprazole is an antacid drug.

A patient with a history of aortic aneurysm presents to the emergency department with pale clammy skin, abdominal tenderness, tachycardia, hypotension, and oliguria. What action should the nurse take?

Clammy skin, abdominal tenderness, altered level of consciousness, tachycardia, hypotension, and decreased urine output are symptoms of aneurysm rupture in a patient with aortic aneurysm. Immediate surgical repair and simultaneous resuscitation is essential in this situation to prevent cardiac arrest; therefore, the nurse should prepare the patient for surgery. Argatroban is used as an anticoagulant, and it does not reverse the effects of aneurysm rupture. The ankle-brachial index is measured to diagnose peripheral artery disease. Administering fluids and electrolytes can maintain electrolyte balance but do not reverse the effects of aneurysm rupture.

The nurse assesses a patient postoperatively from a repair of an aortic aneurysm and finds a heart rate of 48, cool, pale, and mottled extremities along with reports of pain. What condition does the nurse suspect is occurring?

Decreased pulse rate; cool, pale, and mottled extremities; and pain in extremities are symptoms of graft occlusion after aortic aneurysm surgery. Immediate treatment is needed for this condition. Redness, swelling, and drainage at surgical site, elevated body temperature, and increased white blood cells count are symptoms of infection. Tachycardia, an altered level of consciousness, clammy skin, abdominal tenderness, and decreased urine output are symptoms of aneurysm rupture. Bluish fingers and toes, pallor, pain, and numbness are symptoms of Raynaud's phenomenon.

The nurse assesses a patient with diaphoresis, weakness, periumbilical pain, pallor, and a pulsating abdominal mass. The patient's heart rate is 120 beats/minute and blood pressure is 90/60 mm Hg. What does the nurse suspect is occurring with this patient?

Dilation of the aorta indicates aortic aneurysms. Diaphoresis, weakness, periumbilical pain, tachycardia, pallor, pulsating abdominal mass, and hypotension are the symptoms of aneurysm rupture. Marfan's syndrome is a genetic disorder, and it affects the body's connective tissue. Dizziness, depression, fatigue, and erectile dysfunction are adverse effects of metoprolol. Tenderness, itching, redness, warmth, pain, and inflammation of the leg vein are the symptoms of superficial vein thrombosis.

The nurse expects which postoperative findings in a patient who underwent an aortic surgery and experienced a disrupted blood supply to the bowel during the surgery? Select all that apply.

Disruption of blood supply to the bowel during an aortic surgery results in temporary ischemia of the intestinal tissue. Bloody stools, abdominal distention, and absence of bowel sounds are symptoms of temporary ischemia of intestinal tissue. Pallor and diaphoresis are symptoms of aneurysm rupture.

A patient develops edema following peripheral artery bypass surgery. The nurse should place the patient in what position?

Edema of the lower extremity may occur after peripheral artery bypass surgery due to an excessive volume of fluid accumulation in the tissues. The supine position with elevating the leg above heart level helps reduce edema. The sitting position will increase edema. The side-lying position will not help in venous return. The knee-flexed position may increase edema.

A patient reports chest pain. The nurse finds that the patient is diaphoretic and pale. Which diagnostic test can be used to rule out cardiac ischemia?

Electrocardiogram is used to rule out cardiac ischemia. Echocardiography is used to assess the function of the aortic valve. A computed tomography scan is used to determine the presence of thrombus in the aneurysm. Magnetic resonance imaging is used to diagnose and assess the location and severity of aneurysms.

A patient who underwent an aortic surgery has a body temperature of 101° F and a white blood cell count of 13,000/mcL, and the surgical site has redness, swelling, and drainage. What does the nurse infer from these findings?

Elevated body temperature, redness, swelling, drainage at the surgical site, and elevated white blood cell count indicate infection. Buerger's disease is a condition characterized by inflammation and thrombosis in medium-sized blood vessels. Bluish fingers and toes, pallor, pain, and numbness are symptoms of Raynaud's phenomenon. An elevated C-reactive protein level is a sign of peripheral artery disease.

Which nursing action is beneficial for a patient who underwent an abdominal aortic aneurysm repair and develops endoleak?

Endoleak is characterized by seepage of blood back into the old aneurysm and disturbed hemostasis of the body. Coil embolization is used after abdominal aortic aneurysm repair to maintain hemostasis. Furosemide is a diuretic and is used to treat hypertension. Spinach is rich in vitamin K, and the patient who is on anticoagulant medication should avoid spinach to prevent the risk of bleeding. Aspirin-containing drugs are contraindicated for the patient who is on anticoagulant therapy.

A nurse is caring for a patient with a diagnosis of deep venous thrombosis (DVT). The patient receives a prescription for 30 mg enoxaparin. Which injection site should the nurse use to administer this medication safely?

Enoxaparin is a low-molecular-weight (LMW) heparin that is given as a deep subcutaneous injection in the right and left anterolateral abdomen. Enoxaparin will not be given in the upper quadrant of the buttock. All subcutaneous injections should be given away from scars, lesions, or moles.

What is the rationale behind recommending gene and stem cell therapy to a patient who has critical limb ischemia?

Gene therapy stimulates blood vessel growth and causes angiogenesis and helps improve critical limb ischemia. Opioid analgesics are administered to reduce ischemic pain. Placing the patient's bed in the reverse Trendelenburg position will increase perfusion. Refraining from soaking the patient's feet prevents skin maceration.

Which preoperative nursing interventions are beneficial to a patient who is scheduled for aortic aneurysm surgery the following day? Select all that apply.

In general, aortic surgery patients have a bowel preparation (e.g., laxatives, enema) and skin cleansing with an antimicrobial agent the day before surgery, have nothing by mouth (NPO) after midnight the day of surgery, and receive IV antibiotics immediately before the incision is made. If appropriate, a preoperative visit to the intensive care unit (ICU) may be helpful to the patient and caregiver. On the day of the surgery, the patients may receive medication including essential medications (e.g., antihypertensives), preoperative antibiotic, and a beta blocker if the patient has a history of cardiovascular disease (CVD).

The nurse is caring for a patient with superficial vein thrombosis and expects what assessment findings?

In superficial vein thrombosis, the vein appears as a palpable cord. Tenderness to palpation over the involved vein, presence of edema with pain, and induration of overlying muscle are noted in venous thromboembolism. Edema rarely occurs in superficial vein thrombosis.

A patient with intermittent claudication experiences pain in the leg muscles while exercising that resolves within 10 minutes after stopping. The nurse recognizes that the ischemic pain is a result of the buildup of what?

Intermittent claudication is a symptom of lower extremity peripheral artery disease. Exercise increases lactic acid levels in the body from anaerobic metabolism, which results in intermittent claudication. Nicotine consumption increases blood viscosity and causes peripheral artery disease. Increased triglyceride levels increase the risk of peripheral artery disease. Tobacco smoke increases the risk of peripheral artery disease by increasing homocysteine levels in the body.

A patient is diagnosed with peripheral artery disease (PAD). The nurse anticipates that which medication will be prescribed?

Lipid management is essential in the patient with peripheral artery disease. Statins such as simvastatin lower the low-density lipoprotein (LDL) and triglyceride levels and are used to treat peripheral arterial disease. Sildenafil is used to treat Buerger's disease. Bosentan is used as an endothelin receptor antagonist in patients with Raynaud's phenomenon. Cilostazol is also used to treat Buerger's disease.

The nurse reviews a patient's medical record and notes long-term use of heparin. The nurse identifies that the patient is at risk for what complication?

Long-term use of heparin decreases bone density and increases the risk of osteoporosis. Metoprolol can cause erectile dysfunction. Long-term use of aspirin causes gastrointestinal bleeding. Heparin is used to prevent venous thromboembolism.

A patient is scheduled to undergo surgery for repair of an aortic dissection. Which interventions should the nurse include in the preoperative care plan? Select all that apply.

Many patients are anxious before surgery, and the nurse should attempt to minimize this by providing emotional and psychologic support to the patient. Peripheral pulses should be observed regularly to ensure preoperative stable condition. The nurse should administer opioids and sedatives as ordered to reduce pain and restlessness. Pain and anxiety may increase the blood pressure and heart rate, which may cause the dissection to extend. Therefore, the nurse should keep the patient relaxed and free of pain. The patient should be kept in a semi-Fowler's position to maintain the lowest possible levels of heart rate (less than 60 beats/minute) and systolic BP (less than 120 mm/Hg). These vital parameters help sustain vital organ perfusion. A flat position is not suitable for these patients because this cannot help maintain perfusion.

A patient has undergone aortic dissection repair. During a follow-up visit, the patient reports depression, fatigue, and inability to maintain an erection. The nurse suspects that the cause of the patient's symptoms is what?

Metoprolol is recommended after aortic dissection repair to decrease myocardial contractility. It may cause side effects of depression, fatigue, and erectile dysfunction. Blue color of fingers and toes, pallor, rubor, throbbing, and aching pain due to exposure to cold are symptoms of Raynaud's phenomenon. Decreased ankle-brachial index, decreased Doppler pressures, cool feet, brittle nails, and atherosclerosis are symptoms of peripheral artery disease. Antibiotics change the normal flora of the intestine and decrease the body's ability to synthesize biotin as a side effect.

The nurse suspects what reason that a patient is not responding well to clopidogrel therapy?

Omeprazole interacts with clopidogrel and reduces the therapeutic action of clopidogrel by half. Therefore, clopidogrel should not be administered with omeprazole. Clopidogrel is an antiplatelet drug and is used to treat peripheral artery disease. Low-sodium food will help maintain blood pressure in peripheral artery disease. Clopidogrel is recommended for the patient who has aspirin intolerance. Clopidogrel is recommended for peripheral artery disease.

A patient reports leg pain that awakens the patient at night. The patient reports that the same pain develops in the legs when they are elevated and disappears when the legs are dangled. The nurse assesses a lesion on the inner aspect of the ankle. The nurse suspects what diagnosis?

Night-time leg pain is common in older adults. However, it may also indicate the ischemic resting pain of peripheral vascular disease. Alterations in arterial circulation cause pain that worsens with leg elevation and is relieved when the extremity is dangled because gravity assists in arterial circulation. Lymphatic obstruction would present as edema of an extremity. Venous insufficiency presents as leathery brown skin of the lower legs, edema, and the development of stasis ulcers. Musculoskeletal abnormalities are not related to this disease process.

A patient has an asymptomatic aneurysm that is 5.8 cm in diameter. The nurse anticipates that what will be included in the patient's plan of care?

Surgical repair is recommended for the patient who has asymptomatic aneurysms of greater than 5.5 cm in diameter. Simvastatin is used for lowering the growth rate of aneurysm, but it is not effective for large aneurysms. Doxycycline is an antibiotic, and it is used to reduce the growth of an aneurysm. Hormone therapy is beneficial for the postmenopausal patient.

Which description is characteristic of pain experienced by a patient diagnosed with Raynaud's phenomenon?

Pain associated with Raynaud's phenomenon is caused by vasospasm in small arteries, often in the fingers or toes. The vasospasm decreases circulation, starting with pallor (white), worsening to cyanosis (bluish) and then moving to redness as the blood flow returns to the digit. The pain occurs with the vasospasm and is throbbing in nature. Chest pain that is ripping in nature occurs with aortic dissection. Pain of intermittent claudication occurs with peripheral vascular disease in the lower extremities. This severe leg pain occurs with exercise and is relieved by rest. Rest pain occurs in patients with critical limb ischemia (advanced peripheral vascular disease) and is relieved by lowering the limb because gravity improves circulation.

The nurse provides preoperative instructions to a patient who is scheduled for surgery to repair an abdominal aortic aneurysm. The patient has a history of cardiovascular disease. Which patient statement indicates the need for further teaching?

Patients with cardiovascular disease should receive a beta blocker (e.g., metoprolol) preoperatively. The other statements indicate understanding of the instructions. Patients may have an enema or laxative for the bowel preparation, should not drink anything after midnight the night before, and will receive an antibiotic immediately before the surgical incision is made.

The nurse provides teaching to a patient with critical limb ischemia about foot care. Which statement made by the patient indicates the need for further instruction?

Patients with critical limb ischemia should avoid soaking the feet to prevent skin maceration (or breakdown). Patients with critical limb ischemia must carefully inspect, cleanse, and lubricate both feet to prevent cracking of the skin and infection. Encourage the patient to select soft, roomy, and protective footwear and avoid extremes of heat and cold.

The nurse provides discharge education to a patient who underwent peripheral artery bypass surgery. Which statement made by the patient indicates the need for further teaching?

Peripheral artery bypass surgery routine postoperative wound care includes keeping the incision clean and dry and not disturbing the incision site. Cleaning the incision with soap and water increases the risk for incision site infection. Management of peripheral artery disease includes care for feet and legs. Thick or overgrown toenails and calluses are potentially serious and the health care provider (e.g., podiatrist) must be made aware of this. Also, wear clean cotton or wool socks. To promote increased circulation, participate in regular daily exercise.

The nurse reviews a patient's laboratory results before administering a prescribed dose of vitamin K1. The nurse determines that the medication is both safe to give and is most needed when the international normalized ratio (INR) is at which level?

Phytonadione is the antidote to sodium warfarin (Coumadin), which the patient had been taking before admission. Warfarin is an anticoagulant that impairs the ability of the blood to clot. It is necessary to give phytonadione before surgery to reduce the risk of hemorrhage. The greatest value of the INR indicates the greatest impairment of clotting ability, making 2.1 the correct selection. Values of 1.0, 1.2, and 1.6 indicate lower INR results, which may not require vitamin K1.

The nurse reviews the history of a patient with aortic dissection and identifies what risk factors? Select all that apply.

Predisposing factors for aortic dissection include connective tissue disorders (e.g., Marfan's or Ehlers-Danlos syndrome), male gender, poorly controlled hypertension, and cocaine or methamphetamine use. ALS and NSAID use are not predisposing factors.

A patient is receiving medication through an intravenous catheter. The nurse finds pain, tenderness, warmth, erythema, swelling, and a palpable cord at the site of catheter insertion. The nurse anticipates that what medication will be prescribed?

Presence of pain, tenderness, warmth, erythema, swelling, and a palpable cord at the catheter insertion site indicates phlebitis. Nonsteroidal antiinflammatory drugs (NSAIDs), such as diclofenac, relieve pain and inflammation in patients with phlebitis. Tamoxifen is used to prevent the effects of estrogen on tissues. Metoprolol is used to decrease myocardial contractility. Epoetin alfa is used to stimulate erythropoiesis.

A patient who is diagnosed with critical limb ischemia is not a candidate for bypass surgery or percutaneous transluminal angioplasty (PTA). The nurse anticipates that what medication will be prescribed to decrease rest pain and improve ulcer healing?

Prostanoids, such as Iloprost, are used to decrease rest pain and improve ulcer healing associated with limb ischemia when bypass surgery or PTA is not an option. Aspirin is an antiplatelet. Propranolol is used to treat aortic aneurysms. Hydralazine is used to treat hypertension.

The nurse observes leakage of pus, increased redness and hardness, and wound separation along the incision of a patient who has undergone peripheral artery bypass surgery. What action should the nurse take?

Pus from the incision, increased redness and hardness along the incision, and separation of wound edges are symptoms of infection of the leg incision. The nurse should immediately inform the primary health care provider to ensure safety. Omeprazole is used to prevent acidity. Pentoxifylline is administered to treat intermittent claudication. Endothelial progenitor cell therapy is used to stimulate blood vessel growth.

What is the rationale for the use of ramipril in a symptomatic patient with peripheral artery disease (PAD)?

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor. It reduces hypertension by inhibiting the production of angiotensin II. Nifedipine is used to reduce vasospastic attack. Simvastatin is used to lower low-density lipoproteins. Doxycycline is used to slow the growth rate of aneurysms.

The nurse provides information to a patient with diabetes mellitus about foot care to lower the risk of peripheral artery disease (PAD). Which statements made by the patient indicate a need for additional teaching? Select all that apply.

The patient with diabetes mellitus is at high risk for developing peripheral artery disease. The nurse should teach the diabetic patient to check capillary refill regularly to ensure he or she has proper blood circulation. The patient should wear either all-cotton or all-wool socks. Refraining from soaking the feet will prevent skin maceration. Inspecting feet daily for mottling will help prevent further complications.

A patient is diagnosed with chronic venous insufficiency (CVI), a venous ulcer, peripheral artery disease (PAD), and an arterial stasis ulcer. The nurse determines that compression stockings should not be placed on the patient based on what assessment finding?

Rest pain occurs as PAD progresses and involves multiple arterial segments. Compression stockings are not indicated in the treatment plan for patients with PAD. Elevated blood glucose, possibly indicating uncontrolled diabetes mellitus, and hypertension may or may not indicate arterial problems. Dry, itchy, flaky skin indicates venous insufficiency.

A patient is diagnosed with critical limb ischemia, which resulted from severe chronic peripheral vascular disease. The nurse places the patient's bed in the reverse Trendelenberg position to achieve what desired effect?

Reverse Trendelenberg positions the bed at a straight slant with the top of the bed higher than the foot. This position allows gravity to increase blood flow to dependent extremities. Blood pressure is not lowered significantly by this position. Meticulous hygiene is employed to prevent infection. An antiplatelet medication, such as aspirin, may be prescribed to prevent blood clot formation.

A patient is admitted to the hospital with a diagnosis of abdominal aortic aneurysm. The nurse should monitor the patient for which indications of a ruptured aneurysm? Select all that apply.

Rupture of an aneurysm is the most serious complication. If rupture occurs into the retroperitoneal space, bleeding may be controlled by surrounding anatomic structures, preventing exsanguination and death. In this case the patient often has severe back pain and may or may not have back or flank ecchymosis (Grey Turner's sign). If rupture occurs into the thoracic or abdominal cavity, more than 90% of patients will die from massive hemorrhage. The patient who reaches the hospital will be in hypovolemic shock with tachycardia, hypotension, pale clammy skin, decreased urine output, altered level of consciousness, and abdominal tenderness. A pulsatile mass in the abdomen is indicative of an aneurysm that has not ruptured. Sudden shortness of breath and patchy blue mottling on toes and feet are not indicative of a ruptured aneurysm. A pulsatile mass is found in an abdominal aortic aneurysm, but it is not a symptom of a ruptured aneurysm.

A patient experiences chronic ischemic rest pain that lasts more than 2 weeks and gangrene of the leg as a result of peripheral artery disease (PAD). The patient is not a candidate for revascularization bypass surgery. The nurse expects a prescription for what?

The patient's clinical manifestations indicate critical limb ischemia. Percutaneous transluminal angioplasty is recommended for patients with critical limb ischemia who are not candidates for revascularization bypass surgery. Cilostazol is used to treat Buerger's disease. Bosentan is an endothelin receptor antagonist and is used to treat Raynaud's phenomenon. Plasminogen activator is recommended for the patient if surgical thrombectomy is not possible.

An ankle-brachial index (ABI) test was performed on a male patient who presents with symptoms of peripheral artery disease (PAD). The test results include a classification of PAD severity as 0.80 and an ABI of 1.2. The nurse expects that the patient's treatment plan will include what interventions? Select all that apply.

The clinical significance of the ABI result is normal. The PAD severity classification indicates mild PAD. The patient should maintain a body mass index (BMI) of less than 25 kg/m2. The patient should exercise daily to keep active and prevent weight gain. Antiplatelet agents are critical for reducing the risks of cardiovascular events and death in PAD patients. A patient with symptomatic PAD is treated with angiotensin-converting enzyme (ACE) inhibitors to manage hypertension. A male patient should maintain a waist circumference of less than 40 inches.

The nurse prepares a home care plan for a patient diagnosed with venous thromboembolism (VTE) who is receiving anticoagulant therapy. The plan contains information such as: 1) Avoid injury or trauma that can cause bleeding. 2) Avoid all nonsteroidal antiinflammatory drugs. 3) Contact emergency services if there is blood in urine or stool. 4) Take correct doses of drugs (anticoagulants). 5) Take medication at the same time daily. Which important information was omitted from the plan?

The home care plan for a patient receiving anticoagulant therapy must include information regarding the possible adverse effects of the drug. Cold, blue, and painful feet may be indicative of severe lower extremity VTE, which, if untreated, may cause arterial occlusion and gangrene, and possibly lead to amputation. Garlic and other supplements, such as ginger and vitamins, can increase the risk of severe bleeding and hence should be avoided when a patient is on anticoagulant therapy. Dietary products are not prohibited unless the patient is allergic to them. For maximum benefits, sequential compression devices should be worn all the time, except during bathing, assessment, and ambulation.

A patient experiences an acute aortic dissection. The nurse identifies that what medication can be used to lower the patient's heart rate if a β-blocker is contraindicated?

The initial goal in treating aortic dissection is to maintain the heart rate and blood pressure to prevent stress on the aortic wall. β-adrenergic blockers and calcium channel blockers reduce stress on the aortic wall by decreasing systolic blood pressure and myocardial contractility. Calcium channel blockers such as diltiazem should be administered if β-blockers are contraindicated. Morphine reduces pain. Raloxifene is used to prevent osteoporosis. Epoetin alfa is used to stimulate erythropoiesis.

The nurse reviews the coagulation profile results of a patient who is scheduled for surgery. The nurse concludes that the patient is stable for surgery after noting which international normalized ratio (INR) result?

The larger the INR number, the greater the amount of anticoagulation. For this reason, a level of 1.0 indicates that it is safe to proceed with the planned surgery.

A patient with a suspected acute aortic dissection tells the nurse, "I think I'm having a heart attack!" The nurse should assess the patient for which manifestation of an acute aortic dissection?

The majority of patients with an acute ascending aortic dissection report abrupt onset of excruciating chest or back pain radiating to the neck or shoulders. Patients with acute descending aortic dissection are more likely to report pain located in their back, abdomen, or legs. The pain is frequently described as "sharp" and "worst ever," followed less frequently by "tearing," "ripping," or "stabbing." Dissection pain can be differentiated from myocardial infarction (MI) pain, which is more gradual in onset and has increasing intensity. As the dissection progresses, pain may migrate. Older patients are less likely to have abrupt onset of chest or back pain and more likely to have hypotension and vague symptoms. Some patients have a painless aortic dissection, emphasizing the importance of the physical examination.

The nurse is preparing a patient for aortic surgery. Which medication should the nurse administer in the preoperative phase?

The nurse should administer an intravenous antibiotic to the patient just before an aortic surgery to prevent the risk of infection. Laxatives should be administered to the patient a day before surgery for clear bowel movement. Analgesics may be given postoperatively. Antihypertensives such as nifedipine are used to reduce the severity of vasospastic attack.

Which interventions should the nurse implement before surgery for a patient who is scheduled for aortic dissection repair? Select all that apply.

The nurse should administer sedation to the patient before aortic dissection repair because it prevents extension of the dissection and helps in managing pain. Changes in the peripheral pulses indicate changes in the blood pressure and should be monitored. Placing the patient in semi-Fowler's position helps maintain vital organ perfusion and ensures normal heart rate and systolic blood pressure. Dabigatran is an oral direct thrombin inhibitor that is used to prevent venous thromboembolism after elective joint replacement. The nurse should place the patient's bed in the reverse Trendelenburg position if the patient has critical limb ischemia to reduce edema of lower extremities.

The nurse is providing postoperative care to a patient who underwent aneurysm repair surgery. The nurse should monitor what parameters? Select all that apply.

The nurse should check the WBC count for an indication of infection. The status of renal perfusion should be monitored by assessing the BUN and serum creatinine levels. Monitoring blood glucose and thyroid hormone levels are not included in the guidelines for postoperative care for this type of surgery.

Which instructions should the nurse provide to a patient who is receiving anticoagulant therapy? Select all that apply.

The nurse should instruct the patient to take medication at the same time each day to obtain the desired therapeutic effect. Presence of blood in stool indicates gastrointestinal bleeding; the patient should contact emergency medical services immediately. The patient should avoid taking aspirin while receiving anticoagulant therapy to prevent the risk of bleeding. Spinach and kale are rich in vitamin K; vitamin K-rich foods should be avoided to prevent the risk of bleeding.

Which statement made by the student nurse indicates the need for additional teaching about appropriate postoperative interventions for a patient who has undergone peripheral artery bypass surgery?

The nurse should not measure the ankle-brachial index after peripheral artery bypass surgery because it may increase the risk for graft thrombosis. Turning the patient and positioning him or her frequently with pillows supports the incision. Using elastic compression stockings helps control leg edema. Avoiding sitting with the legs dangling will prevent pain and edema.

The nurse provides discharge instructions to a patient who underwent an abdominal aortic aneurysm repair. Which statement made by the patient indicates understanding of the teaching?

The patient or caregiver should immediately tell the primary health care provider about increased redness, increased pain, or drainage after surgery. These symptoms can be an indication of endoleak or aneurysm growth below and above the graft. If not treated immediately, severe tissue damage or even death may occur. Fatigue, poor appetite, irregular bowel habits, and body temperature of 100°F are common postoperative symptoms and need not be reported.

The nurse is reviewing discharge instructions with a patient who is taking warfarin as treatment for venous thromboembolism (VTE). Which substances will the patient need to avoid while taking warfarin? Select all that apply.

The patient receiving oral anticoagulants therapy needs to be taught to avoid taking antiplatelets (e.g., aspirin), nonsteroidal antiinflammatory drugs (NSAIDs), ginkgo biloba, black cohosh, and other dietary and herbal supplements. Acetaminophen can be taken with oral anticoagulants. Foods containing vitamin K can be eaten as long as the intake of these foods is consistent

The nurse teaches dietary measures to a patient who underwent peripheral artery bypass surgery. Which patient actions indicate effective learning? Select all that apply.

The patient should eat healthy since it is essential to recovery. The nurse should recommend that the patient increase fruits, vegetables, and foods that are high in Vitamin A, Vitamin C, and zinc. The patient should increase vegetable intake and does not need to limit kale, broccoli, or carrots.

What is the reason behind placing the bed in the reverse Trendelenburg position while the nurse cares for a patient with critical limb ischemia?

The patient with critical limb ischemia has a risk of edema. Placing the patient's bed in the reverse Trendelenburg position will increase perfusion to the lower extremities and reduce the risk of edema. Placing the patient's bed in the reverse Trendelenburg position does not affect restenosis. Keeping the patient's feet dry can prevent skin maceration. Maintaining hygienic conditions and covering ulcers with dry and sterile dressings reduces the risk of infection.

Which patient is at high risk for developing irreversible renal failure after an aortic aneurysm surgery?

The patient with diabetes may have decreased renal perfusion from embolization of the aortic thrombus or plaque in one or both of the renal arteries. This can cause renal ischemia and can result in permanent renal failure. The patient with spinal cord injury has risk of venous stasis due to prolonged immobilization. The patient with critical limb ischemia has a risk of edema. The patient with hyperhomocysteinemia has a risk of peripheral arterial disease.

A patient reports pain and itchiness in a lower extremity. Upon further assessment, a nurse observes that the extremity is reddened and warm. The patient's body temperature is 101° F. What complication does the nurse suspect?

The presence of an itchy, reddened, painful, and warm lower extremity characterizes a superficial vein thrombosis. A patient with superficial vein thrombosis may also have an elevated body temperature. Altered bowel elimination, abdominal and chest pain are symptoms of an aortic aneurysm. Bluish fingers and toes, pallor, rubor, throbbing, and aching pain due to exposure to cold are symptoms of Raynaud's phenomenon. Atherosclerosis, arterial stenosis, and decreased Doppler pressures are symptoms of peripheral artery disease.

The nurse is providing postoperative care to a patient that underwent aortic aneurysm repair surgery. The nurse should perform what intervention to maintain graft patency?

The priority is to maintain an adequate BP (determined by the health care provider) to maintain graft patency. Prolonged low BP may result in graft thrombosis. Giving IV fluids will help maintain adequate blood flow. Renal output is assessed when the aneurysm repair is above the renal arteries to assess, not to maintain, graft patency. Hypertension may cause undue stress on arterial anastomoses, resulting in leakage of blood or rupture at the suture lines, which is when IV antihypertensives may be used.

A patient who underwent abdominal aortic aneurysm repair is found to have seepage of blood back into the old aneurysm. What reason does the nurse suspect for this finding?

The seepage of blood back into the old aneurysm indicates endoleak. This may be due to inadequate sealing at either side of the graft end, a tear through the graft fabric, or a leakage between overlapping graft segments. Hyperhomocysteinemia increases the risk of peripheral arterial disease. Phlegmasia cerulea dolens occurs due to advanced-stage cancer. Vitamin K-rich food should be avoided in a patient who is receiving anticoagulant treatment.

The nurse provides care for a patient 1 day after the patient underwent peripheral artery bypass surgery. What is an appropriate nursing intervention?

To avoid blockage of the graft or stent, the patient should walk several times on postoperative day one and on subsequent days. Having the patient's knees flexed for sitting in a chair or in bed increases the risk of venous thrombosis and may place stress on the suture lines.

The nurse is providing preoperative care to a patient who is scheduled for an abdominal aortic aneurysm (AAA) repair surgery. The medication history reveals that the patient takes warfarin daily. The nurse should prepare to administer which medication?

Warfarin is a vitamin K antagonist anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, vitamin K is given as the antidote for warfarin. Protamine sulfate is the antidote for heparin sodium and cobalamin is vitamin B12. Heparin sodium is not the antidote for warfarin.

What interventions will decrease the likelihood of a patient developing varicose veins? Select all that apply

Varicose veins are dilated, tortuous veins that occur mainly in the legs. Family history is thought to be a factor in the development of incompetent valves in the leg veins that become varicose veins. Strategies that promote competent veins in the legs include walking, avoiding standing and sitting for long periods of time, and keeping an ideal body weight. Aspirin therapy will not prevent varicose veins. Hydrating lotions will condition the skin but not prevent varicose veins.

The nurse reviews the medical records of four patients and identifies that which patient is at risk for venous thromboembolism?

Venous thromboembolism is a condition associated with both deep vein thrombosis (DVT) and pulmonary embolism (PE) in a patient. Hormone therapy decreases clotting factors (such as fibrinogen, protein S, protein C, tissue factor pathway inhibitor [TFPI], and antithrombin), which increases the risk of venous thromboembolism. Therefore, patient A is at a high risk for developing venous thromboembolism. Patient B, with hyperuricemia (excess uric acid in the blood), is at a high risk for developing peripheral artery disease. Nadroparin is an anticoagulant. Patient C, who is receiving anticoagulant therapy as well as aspirin, has a higher risk of bleeding. Patient D, with high C-reactive protein levels, is at a high risk for peripheral artery disease.

The nurse understands that venous ulcers are characterized by which assessment findings? Select all that apply.

Venous ulcers are often quite painful. Pain may be worse when the leg is in a dependent position. Venous ulcers classically are located above the medial malleolus. A blue tinge to the skin is associated with decreased arterial oxygenation to the tissue. Venous ulcers have a bronze-brown pigmentation, and the capillary refill of the extremity is less than 3 seconds with venous disease. Well-defined edges are seen with arterial ulcers.

While caring for a patient, the nurse observes indications of warfarin toxicity. The nurse expects that which medication will be prescribed?

Vitamin K is an antidote for warfarin toxicity. Lepirudin, protamine, and argatroban do not reverse the anticoagulant properties of warfarin. Lepirudin, a hirudin derivative, is an anticoagulant. Protamine is an antidote for unfractionated heparin (UH). Argatroban, a synthetic thrombin inhibitor, is also an anticoagulant.

A patient has a 2-month history of taking warfarin as treatment for deep vein thrombosis (DVT). The patient is scheduled for an unrelated surgery. The nurse determines that it is safe and necessary to give vitamin K based on what international normalized ratio (INR) result?

Vitamin K is the antidote to warfarin. Warfarin is an anticoagulant that impairs the ability of the blood to clot; therefore, it is necessary to give vitamin K before surgery to reduce the risk of hemorrhage. The value of the INR indicates an impairment of clotting ability, making 3.4 the correct selection. For a patient with a history of VTE, a therapeutic INR is maintained between 2.0 and 3.0.

A 28-year-old female patient inquires about options for contraception. The nurse recognizes that if the patient takes an estrogen-based oral contraceptive, her risk for venous thromboembolism (VTE) doubles based on what statement that is made by the patient?

Women of childbearing age who take estrogen-based oral contraceptives or postmenopausal women on oral hormone therapy (HT) are at increased risk for VTE. Women who use oral contraceptives and tobacco double their risk. Smoking causes hypercoagulability by increasing plasma fibrinogen and homocysteine levels and activating the intrinsic coagulation pathway. Occupations in which a patient is mobile, hot tub use, and previous childbirth do not indicate increased risk of VTE.