Perfusion

What is the rationale for the use of ramipril in a symptomatic patient with peripheral artery disease (PAD)? 1 Reduces hypertension 2 Reduces vasospastic attack 3 Lowers low-density lipoproteins 4 Slows growth rate of aneurysm

1 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.

Which of the following terms refer to the failure to recognize familiar objects perceived by the senses? a) Agnosia b) Perseveration c) Apraxia d) Agraphia

Agnosia Auditory agnosia is failure to recognize significance of sounds. Agraphia refers to disturbances in writing intelligible words. Apraxia refers to inability to perform previously learned purposeful motor acts on a voluntary basis. Perseveration is the continued and automatic repetition of an activity, word, or phrase that is no longer appropriate.

A patient's assessment findings include a waist circumference of 42 inches, current tobacco use, hypertension, and a sedentary lifestyle. The nurse recognizes that which finding is the most important risk factor for peripheral artery disease (PAD)? 1 Tobacco use 2 Excess weight 3 Sedentary lifestyle 4 High blood pressure

1 Significant risk factors for PAD include tobacco use, diabetes, hyperlipidemia, elevated C-reactive protein, and uncontrolled hypertension, with the most important being tobacco use. Excess weight, sedentary lifestyle, and high blood pressure are not significant risk factors for PAD.

During a class on stroke, a junior nursing student asks what the clinical manifestations of stroke are. What would be the instructor's best answer? a) "Clinical manifestations of a stroke depend on the area of the cortex, the affected hemisphere, the degree of blockage, and the availability of collateral circulation." b) "Clinical manifestations of a stroke generally include aphasia, one-sided flaccidity, and trouble swallowing." c) "Clinical manifestations of a stroke depend on how quickly the clot can be dissolved." d) "Clinical manifestations of a stroke are highly variable, depending on the cardiovascular health of the client."

"Clinical manifestations of a stroke depend on the area of the cortex, the affected hemisphere, the degree of blockage, and the availability of collateral circulation." Clinical manifestations following a stroke are highly variable and depend on the area of the cerebral cortex and the affected hemisphere, the degree of blockage (total, partial), and the presence or absence of adequate collateral circulation. (Collateral circulation is circulation formed by smaller blood vessels branching off from or near larger occluded vessels.) Clinical manifestations of a stroke do not depend on the cardiovascular health of the client or how quickly the clot can be dissolved. Clinical manifestations of a stroke are not "general" but individual.

A patient with peripheral arterial disease (PAD) underwent atherectomy. During the immediate postoperative period, the patient's neurovascular checks were normal. The nurse assesses the patient 2 hours after the surgery and notes that the peripheral pulses are absent. What action should the nurse take? 1 Notify the surgeon immediately. 2 Recognize that it is the result of arterial spasm and continue to monitor. 3 Perform ankle-brachial index measurement. 4 Place the patient in a sitting position with legs dangling.

1 Postoperatively, loss of palpable pulse indicates obstruction in the blood vessel. The surgeon should be immediately notified for prompt treatment. It is not a normal finding in the postoperative period, and immediate action needs to be taken to manage it. Ankle-brachial index measurement is not recommended immediately after surgery because the graft can get thrombosed. The patient should not be made to sit with legs in dependent position because this can increase the swelling and edema.

A patient who underwent percutaneous transluminal angioplasty (PTA) to treat lower leg peripheral artery disease is prescribed 75 mg of aspirin daily. What is the desired effect of this medication? 1 Prevent platelet agglutination 2 Stimulate collateral circulation 3 Decrease liver production of vitamin K 4 Control pain resulting from the procedure

1 Aspirin is prescribed for its antiplatelet effect. It interferes with platelet agglutination (sticking together to form a blood clot). Exercise is a means to improve collateral circulation. Warfarin (Coumadin) is an anticoagulant that blocks vitamin K production by the liver. A single daily dose of 75 mg of aspirin is insufficient for pain relief.

Which condition should the nurse check in the patient's history before administering cilostazol? 1 Heart failure 2 Diabetes mellitus 3 Buerger's disease 4 Intermittent claudication

1 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 develops postthrombotic syndrome. The nurse assesses lipodermatosclerosis, which has what hallmark characteristic? 1 Leathery, brown-colored skin 2 Swollen leg 3 Blue-colored skin 4 Presence of cordlike veins

1 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 reports a recent onset of pain in the calf when climbing stairs. The pain is relieved when the patient sits and rests for about 2 minutes. The patient is then able to resume activities. The nurse suspects what condition? 1 Intermittent claudication 2 Muscle cramping 3 Venous insufficiency 4 Sore muscles from overexertion

1 Intermittent claudication feels like a cramp and is caused by decreased arterial blood flow to an extremity during activity. It may be caused by arterial spasm, atherosclerosis, or occlusion of an artery to the limb. Symptoms are usually relieved by a few minutes of rest, and definitive treatment depends on the cause. Muscle cramping, venous insufficiency, and sore muscles from overexertion are all incorrect in light of the patient's presenting complaints.

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? 1 Osteoporosis 2 Erectile dysfunction 3 Gastrointestinal bleeding 4 Venous thromboembolism

1 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 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? 1 Duplex ultrasound 2 Contrast venography 3 Magnetic resonance venography 4 Computed tomography venography

1 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 who has undergone peripheral artery bypass surgery reports increased pain and tingling in the extremities. The nurse notes the loss of a previously palpable pulse, cyanosis, and a decreased ankle-brachial index. The nurse identifies that the assessment findings are related to what condition? 1 Blockage of the graft 2 Compartment syndrome 3 Thoracic aortic aneurysms 4 Superficial vein thrombosis

1 The loss of a previously palpable pulse, increase in pain, cyanosis, a decrease in the ankle-brachial index, and tingling of extremities indicate a blockage of the graft. It is an emergency condition and needs immediate treatment from the primary health care provider. Compartment syndrome can result in swelling of extremities. Deep, diffuse chest pain extending to the interscapular area is a sign of thoracic aortic aneurysms. Superficial vein thrombosis indicates thrombus formation in a superficial vein.

The nurse teaches self-care instructions to a patient who has undergone peripheral artery bypass surgery. Which patient action indicates the need for further teaching? 1 Sits cross-legged 2 Reduces salt intake 3 Eats food high in protein 4 Files toenails straight across

1 The patient who has undergone peripheral artery bypass surgery should not sit with legs crossed. It can increase pain and edema and increase the risk of venous thrombosis. Reducing salt intake maintains normal blood pressure. Protein plays an important role in healing surgical wounds and ensures early recovery from surgery. Filing toenails straight across will reduce the risk of injury.

The nurse reviews the medical records of four patients and identifies that which patient is at risk for venous thromboembolism? 1 A patient on hormone therapy 2 A patient with hyperuricemia 3 A patient receiving anticoagulant therapy as well as aspirin 4 A patient with high C-reactive protein levels 00:00:05 Question Answer Confidence Buttons

1 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.

While caring for a patient, the nurse observes indications of warfarin toxicity. The nurse expects that which medication will be prescribed? 1 Vitamin K 2 Lepirudin 3 Protamine 4 Argatroban

1 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.

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? 1 Vitamin K 2 Cobalamin 3 Heparin sodium 4 Protamine sulfate

1 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.

A patient receives a prescription for 60 mg enoxaparin. Which injection site should the nurse use to administer the medication safely? 1 Abdomen 2 Thigh 3 Deltoid 4 Flank

1 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.

The nurse recognizes that which interventions may benefit a patient with Buerger's disease? Select all that apply. 1 Stopping all use of marijuana 2 Administering a calcium channel blocker 3 Administering an analgesic 4 Maintaining a cold room temperature 5 Utilizing a nicotine replacement product

1,2,3 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.

A patient has undergone peripheral artery bypass surgery. The patient is diabetic, has a history of chronic ischemic rest pain, and has been taking opioids for more than a year. Which postoperative nursing interventions are appropriate for the patient? Select all that apply. 1 Monitor perfusion to the extremities 2 Suggest the patient stop taking opioids 3 Encourage the patient to practice meticulous foot care 4 Teach the patient or caregiver about wound management 5 Encourage the patient to drink juices with refined sugar 6 Report any potential complications, such as bleeding or thrombosis

1,2,4,6 The nurse must monitor perfusion to the extremities; any abnormalities may indicate further complications or blockage in the arteries. These abnormalities must be reported to the primary health care provider. Foot care is very important in these patients because they are more susceptible to foot ulcers or other injuries that may lead to limb amputation. The nurse should teach the patient and caregiver about wound management at home. Diabetic patients with peripheral arterial disease (PAD) require extra care after surgery because of the slow recovery process. The nurse should immediately report to the health care provider any potential complications, such as bleeding and thrombosis, because they can lead to surgical site infection (SSI). Because the patient has been taking opioids for more than one year, its withdrawal symptoms can be very dangerous. Therefore, rather than suggesting the patient stop opioids, administering a more aggressive pain reliever would be a better way to deal with opioid tolerance. Diabetic patients with PAD must be encouraged to practice a diet free of refined sugar in order to maintain the appropriate sugar level.

The nurse identifies that what interventions are appropriate to be included on the plan of care for a patient receiving anticoagulant therapy? Select all that apply. 1 Checking the platelet count 2 Administering stool softeners 3 Utilizing the intramuscular route for medication administration 4 Using large-gauge needles for venipunctures 5 Applying manual pressure for at least 10 minutes on venipuncture sites

1,2,5 The nurse should check the platelet count because anticoagulant therapy may induce thrombocytopenia. Stool softeners prevent hard stools, which reduces straining and the risk of bleeding. The nurse should apply manual pressure for at least 10 minutes on the venipuncture site to prevent bleeding. The nurse should avoid administering an intramuscular injection to the patient to prevent a hematoma formation. The nurse should use small-gauge needles for venipunctures to prevent bleeding.

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. 1 Monitor platelet count. 2 Use restraints as needed. 3 Use small-gauge needle for venipunctures. 4 Avoid manual pressure at venipuncture sites. 5 Humidify O2 source if supplemental O2 is prescribed

1,3,5 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.

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. 1 Do not smoke or use any tobacco products. 2 Wear tight, warm clothing in the wintertime. 3 Identify strategies to reduce emotional stress. 4 Placing hands in cool water often decreases the vasospasm. 5 Do not use drugs that contain pseudoephedrine.

1,3,5 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

A client with a deep vein thrombosis experiences acute chest pain and dyspnea. The nurse should perform which of the following? (Select all that apply.) 1. Elevate the head of the bed 2. Check the pulse in the affected extremity 3. Flex the client's knees and place in a supine position 4. Notify the physician of the situation

1. Elevate the head of the bed 4. Notify the physician of the situation

The nurse on the postpartum unit is reviewing clients' charts. Which of the following clients will the nurse plan to monitor closely due to increased risk for deep vein thrombosis (DVT)? The client with: (Select all that apply.) 1. Pregnancy-induced hypertension (PIH) 2. High parity 3. Varicose veins 4. Prematurity 5. Multiple births

1. Pregnancy-induced hypertension (PIH) 2. High parity 3. Varicose veins

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? 1 Bosentan 2 Paclitaxel 3 Doxycycline 4 Amphetamine

2 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 reviews the treatments for lower extremity peripheral artery disease (PAD). Which therapy involves percutaneous transluminal angioplasty (PTA) and cold therapy? 1 Stent 2 Cryoplasty 3 Atherectomy 4 Endothelial progenitor cell therapy

2 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? 1 Bosentan 2 Protamine 3 Nifedipine 4 Metoprolol

2 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 develops edema following peripheral artery bypass surgery. The nurse should place the patient in what position? 1 Sitting position 2 Supine position 3 Side-lying position 4 Knee-flexed position

2 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.

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? 1 "I will not wear tight shoes." 2 "I will soak my feet every evening." 3 "I will make sure to apply lotion to my feet each day." 4 "I will inspect my feet daily to look for skin cracking or sores." 00:00:09 Question Answer Confidence Buttons

2 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.

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? 1 Tamoxifen 2 Diclofenac 3 Metoprolol 4 Epoetin alfa

2 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 reports fingers and toes that change in color from pallor to cyanotic to rubor, especially when being exposed to cold temperatures. The patient states that, after the color changes, the digits are throbbing, achy, and tingly. The nurse suspects what diagnosis? 1 Aortic aneurysm 2 Raynaud's phenomenon 3 Post-thrombotic syndrome 4 Superficial vein thrombosis

2 Raynaud's phenomenon is an episodic vasospastic disorder of small cutaneous arteries that occurs due to exposure to cold, caffeine use, emotional upsets, and tobacco use. An aortic aneurysm is an abnormal enlargement or bulging of the aorta, which manifests in altered bowel elimination and abdominal and chest pain. Aching, heaviness, swelling, cramps, and itching are symptoms of post-thrombotic syndrome. Superficial vein thrombosis causes thrombus formation in superficial veins.

A male Hispanic patient is diagnosed with peripheral artery disease (PAD). The nurse notes a history of smoking and a history of depression. The nurse identifies that the patient has what PAD risk factor? 1 Gender 2 Smoking 3 Ethnicity 4 Comorbidity

2 Smoking is the most significant risk factor for this patient. PAD is a marker of advanced systemic atherosclerosis. Being male or Hispanic are not risk factors for PAD. Depression also is not a risk factor.

The primary health care provider prescribes warfarin for a patient with venous thromboembolism (VTE). Which information should the nurse include in the patient's discharge teaching plan? 1 No routine laboratory monitoring is needed. 2 Avoid contact sports and high-risk activities. 3 Increase daily intake of dark leafy vegetables. 4 Continue to use garlic as a dietary supplement.

2 Teaching for a patient prescribed warfarin includes avoiding any trauma or injury that might cause bleeding, such as contact sports. Routine laboratory monitoring is needed to assess the therapeutic effect of the medication and whether a change in drug dose is needed. Do not increase daily intake of dark leafy vegetables because these foods are high in vitamin K. Garlic may affect blood clotting. Instruct the patient to consult with the health care provider about the use of garlic supplements along with warfarin.

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? 1 Monitoring for adverse effects of anticoagulant use 2 Administering prescribed subcutaneous anticoagulants 3 Providing instructions about the use of pressure to stop bleeding 4 Teaching about the use of compression stockings during a hospital discharge 00:00:02 Question Answer Confidence Buttons

2 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

The nurse assesses a patient who is diagnosed with acute arterial ischemia in the leg. Which early clinical manifestation requires immediate intervention? 1 Paralysis 2 Paresthesia 3 Leg cramps 4 Referred pain

2 The health care provider must be notified immediately if any of the six Ps of acute arterial ischemia occurs to prevent ischemia from quickly progressing to tissue necrosis and gangrene. The six Ps are: paresthesia, pain, pallor, pulselessness, and poikilothermia, and paralysis. Paralysis is a late sign, indicating the death of nerves to the extremity. Leg cramps are more common with varicose veins. The pain is not referred.

The nurse is preparing to administer enoxaparin subcutaneously to a patient with vascular insufficiency. What technique should the nurse use when administering the medication? 1 Spread the skin before inserting the needle. 2 Leave the air bubble in the prefilled syringe. 3 Use the back of the arm as the preferred site. 4 Sit the patient at a 30-degree angle before administration.

2 The nurse should not expel the air bubble from the prefilled syringe because it should be injected to clear the needle of medication and to avoid leaving medication in the needle track in the tissue. The skin is not spread before inserting the needle. The abdomen is the preferred site of administration. The patient does not sit at a 30-degree angle for administration.

The nurse provides care for a patient 1 day after the patient underwent peripheral artery bypass surgery. What is an appropriate nursing intervention? 1 Maintain patient bed rest 2 Assist the patient with walking several times 3 Encourage the patient to sit in the chair several times 4 Place the patient in a side-lying position with the knees flexed

2 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 assesses four patients and identifies that which patient is at risk for venous stasis? 1 Patient A NIDDM 2 Patient B spinal cord injury 3 Patient C glaucoma 4 Patient D hyperhomocysteinemia

2 Venous stasis occurs because of reduced action of the muscles in the extremities and the functional inadequacy of venous valves. A spinal cord injury causes muscle inactivity and prolonged immobilization, which can lead to venous stasis. Thus, Patient B is most susceptible. Patients A and D are at a higher risk for peripheral arterial disease. Glaucoma does not lead to muscle inactivity or prolonged immobilization; Patient C is not at risk for venous stasis.

The nurse teaches dietary measures to a patient who underwent peripheral artery bypass surgery. Which patient actions indicate effective learning? Select all that apply. 1 Limiting kale intake 2 Increasing fresh fruit intake 3 Increasing foods high in Vitamin A 4 Limiting foods high in zinc 5 Limiting the intake of broccoli and carrots

2,3 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.

A patient is prescribed warfarin following a deep venous thrombosis and pulmonary embolism. What information should the nurse include in the teaching plan? Select all that apply. 1 Eliminate green vegetables from the diet. 2 Use a soft toothbrush and observe the gums for bleeding. 3 Wear a bracelet that identifies the patient is taking an anticoagulant. 4 Blood coagulation testing is needed only for the first 4 to 6 weeks of therapy. 5 Do not take ibuprofen (Motrin) or aspirin unless prescribed by the primary health care provider.

2,3,5 Warfarin acts as an anticoagulant by inhibiting liver production of vitamin K. Patients are at risk for bleeding and should use a soft toothbrush. Wearing an identification bracelet will alert emergency medical personnel in case the patient is unable to inform them about the medication. Nonsteroidal antiinflammatory medications, including aspirin, potentiate the anticoagulation effect and may cause problems with bleeding. Green vegetables, which are sources of vitamin K, should be taken in consistent amounts but need not be eliminated. The patient taking warfarin will continue to need coagulation laboratory testing (Protime/internationalized normal ratio [INR]) while taking the medication because the anticoagulant effect is influenced by many factors, including medications and diet.

The nurse determines that teaching has been effective for a client with deep vein thrombosis (DVT) when the client states: 1. "I'll use a hard-backed, upright chair instead of my recliner when sitting." 2. "I'll get my blood drawn as scheduled and notify my doctor if I have unusual bleeding or bruising." 3. "I understand why I am not allowed to exercise for the next 6 weeks and will take it easy." 4. "I'll have my partner buy a low-cholesterol cookbook and we'll visit a dietician for a low-cholesterol diet."

2. "I'll get my blood drawn as scheduled and notify my doctor if I have unusual bleeding or bruising."

The nurse is conducting a teaching session at the community center about deep vein thrombosis (DVT). Which of the following attendees at the session does the nurse determine is most at risk for developing DVT? 1. A 41-year-old client who underwent a laparoscopic cholecystectomy 2. A 40-year-old client who smokes and uses oral contraceptives 3. A 63-year-old client post-CVA on anticoagulant therapy 4. A 30-year-old client who is at 1 week postpartum

2. A 40-year-old client who smokes and uses oral contraceptives

A standard of nursing practice associated with the care of a client with deep vein thrombosis includes which of the following? 1. Encourage ambulation to maintain circulation 2. Elevate the legs on a pillow, above the level of the heart to promote venous return 3. Massage the calf to promote vasodilation and reabsorption of excess fluid 4. Remove antiembolic stockings throughout the night to prevent venous stasis

2. Elevate the legs on a pillow, above the level of the heart to promote venous return

Which of the following terms refers to the blood coagulating faster than normal, causing thrombin and other clotting factors to multiply? 1. Embolus 2. Hypercoagulability 3. Venous stasis 4. Venous wall injury

2. Hypercoagulability

Which of the following factors usually causes DVT? 1. Aerobic activity 2. Inactivity 3. Pregnancy 4. Tight clothing

2. Inactivity

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: 1. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3 days for this is exhibit an anticoagulant effect. 2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for this medication to exert an anticoagulation effect. 3. Stimulates production of the body's own thrombolytic substances, but it takes 2-4 days for it to begin. 4. Has the same mechanism action of heparin, and the crossover time is needed for the serum level of warfarin sodium to be therapeutic.

2. Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for this medication to exert an anticoagulation effect.

Which of the following terms best describes the findings on cautious palpation of the vein in typical superficial thrombophlebitis? 1. Dilated 2. Knotty 3. Smooth 4. Torturous

2. Knotty (Varicose veins are dilated and torturous. Normal veins are smooth.)

The nurse is caring for a client with a deep vein thrombosis (DVT) and selects ineffective tissue perfusion as a priority nursing diagnosis based on which of the following assessments? 1. Mild, aching pain described by the client 2. Pallor and coolness of the affected leg 3. Temperature of 102 degrees F 4. Heart rate of 62

2. Pallor and coolness of the affected leg

The nurse teaches the family of an older client who is at risk for developing deep vein thrombosis (DVT) about prevention of the condition. Which of the following will the nurse include in the teaching? 1. Apply elastic hose if swelling develops. 2. Position client to promote venous return. 3. Place pillows under the knees so that hips are flexed. 4. Keep feet squarely on the floor when sitting in a chair.

2. Position client to promote venous return.

Which technique is considered the gold standard for diagnosing DVT? 1. Ultrasound imaging 2. Venography 3. MRI 4. Doppler flow study

2. Venography

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? 1 Buttock, upper outer quadrant 2 Abdomen, anterior-lateral aspect 3 Back of the arm, 2 inches away from a mole 4 Anterolateral thigh, with no scar tissue nearby

2.. 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.

The nurse provides care to a patient diagnosed with thromboangiitis obliterans (Buerger's disease). What is the primary treatment for the disease? 1 Iloprost 2 Bypass surgery 3 Complete cessation of tobacco and marijuana use 4 Cilostazol

3 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 patient on bed rest is scheduled to receive a first dose of enoxaparin. For proper administration, which site should the nurse select for injection? 1 Thigh 2 Flank 3 Abdomen 4 Buttock

3 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 walls. The thigh, flank, and buttock are not appropriate sites related to impaired drug absorption at these sites.

The nurse reviews the care options for patients with lower extremity peripheral artery disease (PAD). Which treatment is used to stimulate blood vessel growth? 1 Urokinase 2 Plasminogen activator 3 Spinal cord stimulation 4 Gene and stem cell therapy 00:00:02 Question Answer Confidence Buttons

4 Gene and stem cell therapy is used to stimulate blood vessel growth, or angiogenesis. Urokinase is recommended to reduce complications associated with a thrombectomy. Plasminogen activator is used if surgical thrombectomy is not recommended. Spinal cord stimulation is helpful to control pain and prevent amputation.

A postoperative patient is receiving enoxaparin. The nurse identifies that the medication is not being effective when what assessment finding is noted? 1 Generalized weakness and fatigue 2 Crackles bilaterally in the lung bases 3 Pain and swelling in the lower extremity 4 Abdominal pain with decreased bowel sounds

3 Enoxaparin is a low-molecular-weight heparin used to prevent the development of deep vein thromboses (DVTs) in the postoperative period. Pain and swelling in the lower extremity can indicate development of DVT and therefore may signal ineffective medication therapy. Generalized weakness, fatigue, abdominal pain, and crackles in the bases of the lungs would not necessitate the use of enoxaparin.

A postoperative patient asks the nurse why daily enoxaparin has been prescribed. How should the nurse respond? 1 "It will help prevent breathing problems after surgery, such as pneumonia." 2 "It will help lower your blood pressure to a safe level, which is very important after surgery." 3 "It will help prevent blood clots from forming in your legs until your level of activity, such as walking, returns to normal." 4 "It is a narcotic pain medication that will help take away any muscle aches caused by positioning on the operating room table."

3 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.

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? 1 Blood viscosity 2 Triglycerides 3 Lactic acid 4 Homocysteine

3 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.

The nurse is assessing a patient with lower-extremity peripheral artery disease (PAD). The nurse expects to find what clinical manifestation? 1 Presence of peripheral pulses 2 Presence of edema in the lower leg 3 Loss of hair on legs, feet, and toes 4 Heaviness in the calf or thigh

3 Patients with lower-extremity PAD experience loss of hair on the legs, feet, and toes. Peripheral pulses are absent, and lower leg edema is absent unless the leg is constantly in a dependent position. Patients with lower extremity PAD generally experience intermittent claudication or rest pain in the foot. Patients with venous disease experience lower leg edema and heaviness in the calf or thigh

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? 1 Administer omeprazole to the patient 2 Administer pentoxifylline to the patient 3 Notify the primary health care provider 4 Provide endothelial progenitor cell therapy

3 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.

Which intervention should the nurse implement while administering heparin sodium to a patient? 1 Aspirating while administering the medication 2 Rubbing the site after administering the medication 3 Rotating the medication administration site frequently 4 Using the intramuscular route for medication administration

3 Rotating the injection site while administering heparin sodium prevents tissue trauma and reduces pain. The nurse should avoid aspiration while administering heparin sodium to prevent tissue damage and hematoma formation. The nurse should avoid rubbing the site after administering heparin sodium to prevent hematoma formation in the patient. Heparin sodium should be administered by subcutaneous route to ensure effective therapeutic drug action.

Which treatment may help prevent amputation in patients with critical limb ischemia? 1 Nifedipine 2 Pseudoephedrine 3 Spinal cord stimulation 4 Providing oxygen via nasal cannula

3 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

The nurse reviews a patient's international normalized ratio (INR) level before administering warfarin to a patient. The nurse recognizes that the INR is a standardized system for reporting what blood coagulation test? 1 Hematocrit (Hct) 2 Hemoglobin (Hgb) 3 Prothrombin time (PT) 4 Partial thromboplastin time (PTT)

3 The INR is a standardized system for reporting prothrombin time (PT). The normal value is 0.75 to 1.25. The therapeutic value is 2 to 3.

The nurse provides discharge teaching to a patient with venous leg ulcers. Which statement made by the patient indicates the need for further education? 1 "I will take a walk daily." 2 "I will try to lose at least 20 pounds." 3 "I will put on my stockings after I get out of bed each day." 4 "I will not wear knee-high socks that are tight around my calf."

3 The patient should apply stockings in bed before rising in the morning (not after rising). Emphasize the importance of periodic positioning of the legs above the heart. Prevention is a key factor related to varicose veins. Instruct the patient to avoid sitting or standing for long periods, maintain ideal body weight, take precautions against injury to the extremities, avoid wearing constrictive clothing, and walk daily. The overweight patient may need assistance with weight loss. The patient with a job that requires long periods of standing or sitting needs to frequently flex and extend the hips, legs, and ankles and change positions.

What is the rationale behind recommending gene and stem cell therapy to a patient who has critical limb ischemia? 1 To reduce pain 2 To increase perfusion 3 To prevent maceration 4 To increase angiogenesis

4 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.

The nurse is talking with a client with suspected deep vein thrombosis (DVT). The client asks the nurse if testing for the disease is invasive. The nurse tells the client that there is a noninvasive diagnostic test for DVT, called: 1. Electrocardiography. 2. Cardiac catheterization. 3. Plethysmography. 4. Ascending venography.

3. Plethysmography.

Which of the following terms is used to describe a thrombus lodged in the lungs? 1. Hemothorax 2. Pneumothorax 3. Pulmonary Embolism 4. Pulmonary Hypertension

3. Pulmonary Embolism

Which of the following characteristics is typical of the pain associated with DVT? 1. Dull ache 2. No pain 3. Sudden onset 4. Tingling

3. Sudden onset

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? 1 Administer an oral anticoagulant 2 Measure the ankle-brachial index 3 Prepare for surgical revascularization 4 Contact the health care provider

4 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.

Which of the following insults or abnormalities can cause an ischemic stroke? a) Arteriovenous malformation b) Intracerebral aneurysm rupture c) Cocaine use d) Trauma

Cocaine use Cocaine is a potent vasoconstrictor and may result in a life-threatening reaction, even with the individual's first use of the drug. Arteriovenous malformations are associated with hemorrhagic strokes. Trauma is associated with hemorrhagic strokes. Intracerebral aneurysm rupture is associated with hemorrhagic strokes.

A patient experiences pain in the calf while exercising and reports that the pain disappears after a few minutes of resting. The nurse recognizes the finding as consistent with what condition? 1 Venous obstruction in the leg 2 Claudication resulting from venous abnormalities 3 Ischemia resulting from complete blockage of an artery 4 Ischemia resulting from partial blockage of an artery

4 Ischemia is a deficient supply of oxygenated arterial blood to tissue. A partial blockage creates an insufficient supply, and the ischemia may be apparent only during exercise, when oxygen needs increase. Claudication does not result from venous abnormalities. Ischemic pain would not disappear with a complete blockage of an artery in the leg; the pain would be constant.

A patient is diagnosed with peripheral artery disease (PAD). The nurse anticipates that which medication will be prescribed? 1 Sildenafil 2 Bosentan 3 Cilostazol 4 Simvastatin

4 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. Cilostazol is also used to treat Buerger's disease. Bosentan is used as an endothelin receptor antagonist in patients with Raynaud's phenomenon.

Which description is characteristic of pain experienced by a patient diagnosed with Raynaud's phenomenon? 1 Ripping type chest pain 2 Leg pain with exercise that resolves with rest 3 Leg pain that resolves when the leg is lowered 4 Pain in fingers or toes with color changes in the skin

4 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.

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? 1 Lower blood pressure 2 Decrease risk for infection 3 Decrease platelet agglutination 4 Increase tissue perfusion by gravity

4 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.

Which ankle-brachial index (ABI) value indicates noncompressible arteries? 1 0.92 2 0.96 3 1.2 4 1.5

4 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 1.3 indicates noncompressible arteries. An ankle-brachial index between 0.91 and 0.99 indicates borderline ABI. An ankle-brachial index between 1 and 1.3 is a normal ABI.

The patient reports a palpable, firm, and cordlike vein. The patient states that the area around the vein is itchy, painful to the touch, reddened, and warm. The nurse recognizes that the condition needs to be treated to prevent what complication? 1 Pulmonary embolism 2 Pulmonary hypertension 3 Postthrombotic syndrome 4 Venous thromboembolism

4 The clinical manifestations are characteristic of a superficial vein thrombosis. If untreated, the clot may extend to deeper veins and venous thromboembolism may occur. Pulmonary embolism, pulmonary hypertension, and postthrombotic syndrome are the sequelae of venous thromboembolism.

What is the reason behind placing the bed in the reverse Trendelenburg position while the nurse cares for a patient with critical limb ischemia? 1 To reduce restenosis 2 To prevent skin maceration 3 To reduce the risk of infection 4 To increase perfusion to the lower extremities

4 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.

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? 1 Throbbing, tingling, and swelling of the limbs 2 Chronic ischemic pain and ulcers on both feet 3 Hypertension, hyperglycemia, and inflamed arteries 4 Color changes of fingers and toes from white to blue to red

4 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.

The nurse reviews the prescribed medications taken by a patient diagnosed with thromboangiitis obliterans (Buerger's Disease). Which medication is contraindicated and should be questioned by the nurse? 1 Cilostazol 2 Nifedipine 3 Acetaminophen 4 Nicotine transdermal patch

4 Thromboangiitis obliterans (Buerger's Disease) is an inflammatory condition of small arteries and veins in the extremities that leads to tissue ischemia and ulcer development. The condition occurs mostly in young males with a history of heavy use of tobacco or marijuana. Treatment involves complete cessation of tobacco to stop the inflammation. A nicotine patch is contraindicated and should be questioned. The condition may be treated with antiplatelet medications such as cilostazol, or a calcium channel blocker agent such as nifedipine, for vasodilation effect. Acetaminophen may be used for pain relief.

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? 1 1.0 2 1.2 3 2.0 4 3.4

4 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.

The nurse observes another health care provider caring for a patient with critical limb ischemia. Which action needs correction? 1 Administering opioid analgesics 2 Keeping a pillow under the patient's calves 3 Covering the ulcers with a dry and sterile dressing 4 Soaking the patient's feet to allow for thorough cleaning

4 Critical limb ischemia is a condition that reduces blood flow to the extremities, causing severe pain and skin ulcers. Soaking the patient's feet can result in skin maceration. The nurse should administer opioid analgesics as ordered to reduce pain. Placing a pillow under the patient's calves reduces the pressure on the heel and helps prevent ulcers. Covering the ulcers with a dry and sterile dressing ensures cleanliness and prevents further infections.

The nurse is preparing to administer a scheduled dose of enoxaparin 30 mg subcutaneously. What technique should the nurse use when administering the medication? 1 Remove the air bubble in the prefilled syringe. 2 Aspirate before injection to prevent intravenous (IV) administration. 3 Rub the injection site after administration to enhance absorption. 4 Hold skinfold during injection but release before removing needle.

4 The nurse should gather together or "bunch up" the skin between the thumb and the forefinger during the injection but should release it before removing the needle. The nurse should not remove the air bubble in the prefilled syringe, aspirate, or rub the site after injection.

Which instructions should the nurse provide to a patient who is receiving anticoagulant therapy? Select all that apply. 1 Take aspirin regularly. 2 Increase the intake of kale. 3 Add spinach to the diet. 4 Take medication at the same time each day. 5 Contact emergency response services (ERS) if there is blood in the stool.

4,5 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.

The nurse anticipates that which medication will be prescribed to a patient with intermittent claudication? 1 Ramipril 2 Warfarin 3 Simvastatin 4 Pentoxifylline

4. Pentoxifylline is used to treat intermittent claudication. Ramipril is an angiotensin-converting enzyme (ACE) inhibitor and is used to treat hypertension. Warfarin is an anticoagulant drug, and it is used to prevent strokes and heart attack. Simvastatin is used to lower low-density lipoprotein and triglyceride levels.

A significant cause of venous thrombosis is: 1. Altered blood coagulation 2. Stasis of blood 3. Vessel wall injury 4. All of the above

4. All of the above

The nurse is assessing a postpartum woman and determines that the client may have a deep vein thrombosis (DVT) when the nurse notes which of the following manifestations? 1. Pain in the abdomen 2. Positive pulses in the affected leg 3. Pain located in the foot 4. Ankle and leg edema

4. Ankle and leg edema

Which of the following treatments can relieve pain from Deep Vein Thrombosis? 1. Application of heat 2. Bed rest 3. Exercise 4. Elevation

4. Elevation

The nurse is caring for a client who is to undergo a venous thrombectomy. The nurse tells the client that the thombus to be removed is most likely located in the: 1. Femoral artery. 2. Posterior tibial vein. 3. Peroneal vein. 4. Femoral vein.

4. Femoral vein.

Which of the following conditions causes intermittent claudication (cramp-like pains in the leg)? 1. Inadequate blood supply 2. Elevated leg position 3. Dependent leg position 4. Inadequate muscle oxygenation

4. Inadequate muscle oxygenation

Which of the following medical treatments should be administered to treat intermittent claudication? 1. Analgesics 2. Warfarin (Coumadin) 3. Heparin 4. Pentoxiphylline (Trental)

4. Pentoxiphylline (Trental)

Which of the following terms is used to describe pain in the calf due to sharp dorsiflexion of the foot? 1. Dyskinesia 2. Eversion 3. Positive Babinski's reflex 4. Positive Homan's sign

4. Positive Homan's sign

The nurse is caring for a patient with a history of transient ischemic attacks (TIAs) and moderate carotid stenosis who has undergone a carotid endarterectomy. Which of the following postoperative findings would cause the nurse the most concern? a) Blood pressure (BP): 128/86 mm Hg b) Neck pain: 3/10 (0 to 10 pain scale) c) Mild neck edema d) Difficulty swallowing

Difficulty swallowing The patient's inability to swallow without difficulty would cause the nurse the most concern. Difficulty in swallowing, hoarseness or other signs of cranial nerve dysfunction must be assessed. The nurse focuses on assessment of the following cranial nerves: facial (VII), vagus (X), spinal accessory (XI), and hypoglossal (XII). Some edema in the neck after surgery is expected; however, extensive edema and hematoma formation can obstruct the airway. Emergency airway supplies, including those needed for a tracheostomy, must be available. The patient's neck pain and mild BP elevation need addressing but would not cause the nurse the most concern. Hypotension is avoided to prevent cerebral ischemia and thrombosis. Uncontrolled hypertension may precipitate cerebral hemorrhage, edema, hemorrhage at the surgical incision, or disruption of the arterial reconstruction.

The nurse is caring for a patient with aphasia. Which of the following strategies will the nurse use to facilitate communication with the patient? a) Speaking in complete sentences b) Speaking loudly c) Avoiding the use of hand gestures d) Establishing eye contact

Establishing eye contact The following strategies should be used by the nurse to encourage communication with a patient with aphasia: face the patient and establish eye contact, speak in your usual manner and tone, use short phrases, and pause between phrases to allow the patient time to understand what is being said; limit conversation to practical and concrete matters; use gestures, pictures, objects, and writing; and as the patient uses and handles an object, say what the object is. It helps to match the words with the object or action, be consistent in using the same words and gestures each time you give instructions or ask a question, and keep extraneous noises and sounds to a minimum. Too much background noise can distract the patient or make it difficult to sort out the message being spoken. (less)

Which disturbance results in loss of half of the visual field? a) Anisocoria b) Homonymous hemianopsia c) Nystagmus d) Diplopia

Homonymous hemianopsia Homonymous hemianopsia (loss of half of the visual field) may occur from stroke and may be temporary or permanent. Double vision is documented as diplopia. Nystagmus is ocular bobbing and may be seen in multiple sclerosis. Anisocoria is unequal pupils.

A nurse is working with a student nurse who is caring for a client with an acute bleeding cerebral aneurysm. Which action by the student nurse requires further intervention? a) Maintaining the client in a quiet environment b) Keeping the client in one position to decrease bleeding c) Positioning the client to prevent airway obstruction d) Administering I.V. fluid as ordered and monitoring the client for signs of fluid volume excess

Keeping the client in one position to decrease bleeding The student nurse shouldn't keep the client in one position. She should carefully reposition the client often (at least every hour). The client needs to be positioned so that a patent airway can be maintained. Fluid administration must be closely monitored to prevent complications such as increased intracranial pressure. The client must be maintained in a quiet environment to decrease the risk of rebleeding.

A client with a cerebrovascular accident (CVA) is having difficulty with eating food on the plate. Which is the best nursing action to be taken? a) Reposition the tray and plate. b) Perform a vision field assessment. c) Know this is a normal finding for CVA. d) Assist the client with feeding.

Perform a vision field assessment. The nurse should perform a vision field assessment to evaluate the client forhemianopia. This finding could indicate damage to the visual area of the brain as a result of evolving CVA. Repositioning the tray and assisting with feeding would not be the best nursing action until new finding has been evaluated. Hemianopia can be associated with a CVA but, when presenting as a new finding, should be evaluated and reported immediately. (less)

While providing information to a community group, the nurse tells them the primary initial symptoms of a hemorrhagic stroke are: a) Footdrop and external hip rotation b) Severe headache and early change in level of consciousness c) Weakness on one side of the body and difficulty with speech d) Confusion or change in mental status

Severe headache and early change in level of consciousness The main presenting symptoms for ischemic stroke are numbness or weakness of the face, arm, or leg, especially on one side of the body, confusion or change in mental status, and trouble speaking or understanding speech. Severe headache, vomiting, early change in level of consciousness, and seizures are early signs of a hemorrhagic stroke. Footdrop and external hip rotation can occur if a stroke victim is not turned or positioned correctly. (less)

An emergency department nurse is interviewing a client with signs of an ischemic stroke that began 2 hours ago. The client reports that she had a cholecystectomy 6 weeks ago and is taking digoxin, coumadin, and labetelol. This client is not eligible for thrombolytic therapy for which of the following reasons? a) She is not within the treatment time window. b) She had surgery 6 weeks ago. c) She is taking digoxin. d) She is taking coumadin.

She is taking coumadin. To be eligible for thrombolytic therapy, the client cannot be taking coumadin. Initiation of thrombolytic therapy must be within 3 hours in clients with ischemic stroke. The client is not eligible for thrombolytic therapy if she has had surgery within 14 days. Digoxin and labetelol do not prohibit thrombolytic therapy.

A client is hospitalized when they present to the Emergency Department with right-sided weakness. Within 6 hours of being admitted, the neurologic deficits had resolved and the client was back to their presymptomatic state. The nurse caring for the client knows that the probable cause of the neurologic deficit was what? a) Cerebral aneurysm b) Transient ischemic attack c) Left-sided stroke d) Right-sided stroke

Transient ischemic attack A transient ischemic attack (TIA) is a sudden, brief attack of neurologic impairment caused by a temporary interruption in cerebral blood flow. Symptoms may disappear within 1 hour; some continue for as long as 1 day. When the symptoms terminate, the client resumes his or her presymptomatic state. The symptoms do not describe a left- or right-sided stroke or a cerebral aneurysm.

The nurse is providing information about strokes to a community group. Which of the following would the nurse identify as the primary initial symptoms of an ischemic stroke? a) Footdrop and external hip rotation b) Vomiting and seizures c) Severe headache and early change in level of consciousness d) Weakness on one side of the body and difficulty with speech

Weakness on one side of the body and difficulty with speech The main presenting symptoms for an ischemic stroke are numbness or weakness of the face, arm, or leg, especially on one side of the body; confusion or change in mental status; and trouble speaking or understanding speech. Severe headache, vomiting, early change in level of consciousness, and seizures are early signs of a hemorrhagic stroke. Footdrop and external hip rotation are things that can occur if a stroke victim is not turned or positioned correctly.

When communicating with a client who has sensory (receptive) aphasia, the nurse should: a) speak loudly and articulate clearly. b) allow time for the client to respond. c) give the client a writing pad. d) use short, simple sentences.

use short, simple sentences. Although sensory aphasia allows the client to hear words, it impairs the ability to comprehend their meaning. The nurse should use short, simple sentences to promote comprehension. Allowing time for the client to respond might be helpful but is less important than simplifying the communication. Because the client's hearing isn't affected, speaking loudly isn't necessary. A writing pad is helpful for clients with expressive, not receptive, aphasia.