Peripheral Vascular Disorders

The nurse obtains a medical history from a patient with a suspected abdominal aortic aneurysm. What question is the priority for the nurse to ask the patient? "Do you have back pain?" "Have you noticed blood in your urine?" "Do you have frequent headaches?" "Are your stools black or tarry?"

"Do you have back pain?" Although an abdominal aortic aneurysm is often asymptomatic, some patients have abdominal or back pain. Signs of aneurysm rupture include back pain and a pulsating mass in the abdomen. Headaches, hematuria, and changes in the color of bowel movements are not signs associated with an abdominal aortic aneurysm. pp. 811, 813

The nurse provides education to a nursing student about postoperative interventions for a patient who has undergone an aortic aneurysm surgery. Which statement made by the student indicates the need for further teaching? "I should assess the patient's body temperature regularly." "I should administer a broad-spectrum antibiotic to the patient." "I should keep an indwelling urinary catheter in place until the patient is discharged."

"I should keep an indwelling urinary catheter in place until the patient is discharged." The early removal of an indwelling urinary catheter reduces the risk of a urinary tract infection. Sodium nitroprusside reduces high blood pressure and prevents rupture of the sutures. The nurse should assess the patient's body temperature regularly. Administering broad-spectrum antibiotics to the patient helps prevent risk of infection.

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? "I will immediately report if there are irregular bowel habits." "I will immediately report if I feel weak and have a poor appetite." "I will immediately report if the pain or drainage from incisions increase." "I will immediately report if my body temperature is 100°F."

"I will immediately report if the pain or drainage from incisions increase." 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. p. 814

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? "I will have some type of bowel preparation the day before surgery." "I should not drink anything after midnight the day of surgery." "I will receive an antibiotic just before the surgery begins." "I will not be allowed to take any medications the day of surgery."

"I will not be allowed to take any medications the day of surgery." 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.

A patient is scheduled for a chest x-ray to determine the cause of a deep, diffuse chest pain extending to the interscapular area. The patient asks the nurse why the test is being performed. How should the nurse respond? "It will map the entire aortic system." "It can help us rule out myocardial infarction." "It can reveal abnormal widening of the thoracic aorta." "It is used to determine the length and cross-sectional diameter of an aneurysm."

"It can reveal abnormal widening of the thoracic aorta." Deep, diffuse chest pain that extends to the interscapular area indicates thoracic aortic aneurysms, and a chest x-ray study is used to find abnormal widening of the thoracic aorta. Angiography is used to map the entire aortic system. An ECG may rule out myocardial infarction since thoracic aneurysm symptoms can mimic angina. A computed tomography (CT) scan is used to determine the length and cross-sectional diameter of an aneurysm. p. 811

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. 1. "You will have an NG tube in place." 2. "You are encouraged to ambulate early to help the return of bowel function." 3. "You won't be allowed to eat or drink anything initially, but you can have ice chips or lozenges if needed." 4. "It often takes up to a week until normal bowel function is restored." 5. "Passing of flatus indicates excessive air in the intestines; additional treatment will be needed."

1. "You will have an NG tube in place." 2. "You are encouraged to ambulate early to help the return of bowel function." 3. "You won't be allowed to eat or drink anything initially, but you can have ice chips or lozenges if needed." 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. p. 813

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. 1. AAAs are often asymptomatic. 2. AAAs often go undetected during routine examinations. 3. AAAs can only be diagnosed by specialized equipment. 4. AAAs may mimic the symptoms of other diseases. 5. Physical findings related to AAAs may be more difficult to detect in obese individuals.

1. AAAs are often asymptomatic. 4. AAAs may mimic the symptoms of other diseases. 5. Physical findings related to AAAs may be more difficult to detect in obese individuals. 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. p. 811

A patient with a history of cardiovascular disease is scheduled for an aortic aneurysm repair surgery. Which interventions should be included on the patient's plan of care to prevent complications during surgery? Select all that apply. 1. Administer a laxative to the patient the day before surgery. 2. Administer clopidogrel to the patient 1 day before surgery. 3. Administer intravenous antibiotic 1 week before surgery. 4. Perform skin cleansing with an antimicrobial agent the day before surgery. 5. Instruct the patient not to eat or drink after midnight on the day of surgery.

1. Administer a laxative to the patient the day before surgery. 4. Perform skin cleansing with an antimicrobial agent the day before surgery. 5. Instruct the patient not to eat or drink after midnight on the day of surgery. Laxatives should be administered a day before the surgery, the skin of the patient should be cleansed with an antimicrobial agent, and the patient should be on nothing by mouth status. Clopidogrel is used to treat peripheral artery disease. Intravenous antibiotics should be administered immediately before making an incision to prevent the risk of infection. p. 813

Which interventions should the nurse implement before surgery for a patient who is scheduled for aortic dissection repair? Select all that apply. 1. Administer sedation to the patient. 2. Administer dabigatran to the patient. 3. Observe changes in the peripheral pulses. 4. Place the patient in semi-Fowler's position. 5. Place the patient's bed in the reverse Trendelenburg position.

1. Administer sedation to the patient. 3. Observe changes in the peripheral pulses. 4. Place the patient in semi-Fowler's position. 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. p. 816

Which preoperative nursing interventions are beneficial to a patient who is scheduled for aortic aneurysm surgery the following day? Select all that apply. 1. Administering a bowel preparation 2. Ensuring that the patient has nothing by mouth (NPO) after midnight 3. Cleansing the skin with an antimicrobial agent 4. Providing for a visit to the intensive care unit, if necessary 5. Informing the patient that no medications will be given after midnight

1. Administering a bowel preparation 2. Ensuring that the patient has nothing by mouth (NPO) after midnight 3. Cleansing the skin with an antimicrobial agent 4. Providing for a visit to the intensive care unit, if necessary 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). p. 813

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. 1. Back or flank ecchymosis 2. Severe low back pain 3. Sudden shortness of breath and hemoptysis 4. Patchy blue mottling on feet and toes and rest pain 5. A pulsatile mass in the periumbilical area, slightly left of the midline

1. Back or flank ecchymosis 2. Severe low back pain 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'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. 1. Back pain 2. Epigastric discomfort 3. Bluish fingers and toes 4. Decreased urine output 5. Altered bowel elimination

1. Back pain 2. Epigastric discomfort 5. Altered bowel elimination 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. p. 811

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. Checking the platelet count 2. Administering stool softeners 5. Applying manual pressure for at least 10 minutes on venipuncture sites 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.

A patient admitted to the health care facility with venous thromboembolism (VTE) is prescribed unfractionated heparin, to be administered subcutaneously. What technique should the nurse use when administering the medication? Select all that apply. 1. Inject deep into abdominal fatty tissue. 2. Hold skinfold during injection. 3. Release skinfold after removing needle. 4. Avoid aspiration. 5. Rub site after injection.

1. Inject deep into abdominal fatty tissue. 2. Hold skinfold during injection. 4. Avoid aspiration.

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. 1. Providing emotional support to the patient 2. Keeping the patient in bed in a supine position 3. Monitoring changes in peripheral pulses 4. Administering opioids and sedatives as prescribed 5. Managing pain and anxiety

1. Providing emotional support to the patient 3. Monitoring changes in peripheral pulses 4. Administering opioids and sedatives as prescribed 5. Managing pain and anxiety 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. p. 816

The nurse is caring for a patient after an open aneurysm repair. Which interventions should the nurse perform? Select all that apply. 1. Record the amount and character of nasogastric output. 2. Assess for bowel sounds every hour. 3. Ensure complete bed rest until the fourth postoperative day. 4. Provide ice chips or lozenges to the patient as needed. 5. Note passing of flatus.

1. Record the amount and character of nasogastric output. 4. Provide ice chips or lozenges to the patient as needed. 5. Note passing of flatus. The nurse should record the amount and character of nasogastric output. While the patient is not taking food or water by mouth, the nurse should ensure oral care frequently, and ice chips or lozenges can help soothe a dry or irritated throat. The passing of flatus signals returning bowel function and should be noted. Bowel sounds should be assessed for every 4 hours. The nurse should encourage early ambulation because this can help with the return of the patient's bowel function.

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. Stopping all use of marijuana 2. Administering a calcium channel blocker 3. Administering an analgesic 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 is providing postoperative care to a patient who underwent aneurysm repair surgery. The nurse should monitor what parameters? Select all that apply. 1. White blood cell (WBC) count 2. Blood urea nitrogen (BUN) level 3. Serum creatinine level 4. Blood glucose level 5. Thyroid hormone level

1. White blood cell (WBC) count 2. Blood urea nitrogen (BUN) level 3. Serum creatinine level 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. pp. 813-814

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? 1.0 1.8 2.7 3.4

1.0 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. pp. 820-821

An ankle-brachial index of more than ????? indicates noncompressible arteries

1.3

Which instructions should the nurse include in the discharge plan of a patient who has undergone aortic surgery? Select all that apply. 1. Avoid consuming broccoli. 2. Avoid heavy lifting for six weeks. 3. Routinely observe the color of the extremities. 4. Palpate the peripheral pulses regularly. 5. Avoid taking aspirin-containing medications.

2. Avoid heavy lifting for six weeks. 3. Routinely observe the color of the extremities. 4. Palpate the peripheral pulses regularly The patient who has undergone aortic surgery should avoid heavy lifting for six weeks to prevent excessive stress on the stitches that may lead to bleeding. Observing the color of extremities daily helps to assess blood circulation. Palpating peripheral pulses regularly helps to determine the changes in blood circulation. Broccoli consumption is restricted in patients who are receiving anticoagulant therapy. Aspirin-containing medications are contraindicated in the patient who is taking anticoagulant medication. p. 814

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. 1. Wearing gloves 2. Drinking caffeinated coffee 3. Exposure to heat 4. Emotional upsets 5. Cigarette smoking

2. Drinking caffeinated coffee 4. Emotional upsets 5. Cigarette smoking 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. p. 810

The nurse reviews the history of a patient with aortic dissection and identifies what risk factors? Select all that apply. 1. Amyotrophic lateral sclerosis (ALS) 2. Marfan's syndrome 3. Male gender 4. Poorly controlled hypertension 5. Cocaine use 6. Long-term use of nonsteroidal antiinflammatory drugs (NSAIDs)

2. Marfan's syndrome 3. Male gender 4. Poorly controlled hypertension 5. Cocaine use 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. p. 814

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. 1. Pallor 2. Diaphoresis 3. Bloody stools 4. Abdominal distention 5. Absence of bowel sounds

3. Bloody stools 4. Abdominal distention 5. Absence of bowel sounds 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. p. 813

A small (4.5 cm) abdominal aortic aneurysm (AAA) has been detected in a patient. The nurse recognizes that which medications may be prescribed to slow the growth rate of the aneurysm? Select all that apply. 1. Aspirin 2. Heparin 3. Propranolol 4. Doxycycline 5. Aminophylline

3. Propranolol 4. Doxycycline Aortic aneurysm is an enlargement of the aorta. Doxycycline is administered to reduce the growth of the aneurysm and prevent infection. Propranolol is a β-adrenergic blocking agent used to reduce the growth of the aortic aneurysm. Aspirin acts as a blood thinner and is used to treat venous thromboembolism. Heparin is an anticoagulant and is used to treat venous thromboembolism. Aminophylline is used to treat asthma. p. 811

Surgical repair is recommended in patients with asymptomatic aneurysms that are what size?

5.5 cm or larger

The nurse is caring for a group of patients and identifies that which patient is at greatest risk for developing acute kidney injury (AKI)? A patient who underwent abdominal aortic aneurysm repair A patient who is receiving long-term treatment with heparin A patient who is receiving nadroparin therapy as well as aspirin A patient who is receiving anticoagulant therapy and eating broccoli frequently

A patient who underwent abdominal aortic aneurysm repair The patient who has undergone abdominal aortic aneurysm repair is at a higher risk of acute kidney injury. Hypotension, dehydration, prolonged aortic clamping during surgery, or blood loss can lead to decreased renal perfusion. The patient who is receiving long-term treatment of heparin is at a high risk of developing osteoporosis. The interaction between nadroparin and aspirin causes a high risk of bleeding. The patient who is receiving anticoagulant therapy and consuming vitamin K-rich foods, such as broccoli, has an increased risk of bleeding. p. 814

The nurse is assigned to care for a group of patients in the intensive care unit. Which patient is at greatest risk for needing a percutaneous catheter decompression? A patient receiving heparin sodium A patient who has dalteparin overdose A patient who underwent endovascular aneurysm repair A patient with severe abdominal compartment syndrome

A patient with severe abdominal compartment syndrome A patient with abdominal compartment syndrome has increased intraabdominal pressure. Therefore, percutaneous catheter decompression is required to reduce the intraabdominal pressure. p. 812

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? Raynaud's phenomenon Peripheral arterial disease A side effect of antibiotics A side effect of metoprolol

A side effect of metoprolol 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.

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

Abdomen, anterior-lateral aspect 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. p. 820

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? Nephrotic syndrome Deep vein thrombosis Peripheral artery disease Abdominal aortic aneurysm

Abdominal aortic aneurysm 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. p. 811

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? Intermittent, stabbing pain in the abdomen Abrupt onset of excruciating chest or back pain Gradual onset of chest pain that increases in intensity Sharp chest pain that happens only with a deep breath

Abrupt onset of excruciating chest or back pain 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. p. 815

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? Assess the output to identify renal dysfunction Administer intravenous (IV) fluids to maintain adequate blood pressure (BP) Administer an oral antihypertensive medication to maintain cardiac output Maintain a low BP to prevent pressure on the surgical site

Administer intravenous (IV) fluids to maintain adequate blood pressure (BP) 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. p. 813

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? Aneurysm rupture Marfan's syndrome Metoprolol adverse effects Superficial vein thrombosis

Aneurysm rupture 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. p. 813

A patient has been diagnosed with an aortic arch aneurysm. What assessment finding does the nurse determine correlates with this diagnosis? Angina Polyphagia Brittle nails Loss of hair on legs

Angina Aortic arch aneurysm may decrease blood flow to the coronary arteries and result in angina. Aortic arch aneurysm may cause pressure on the esophagus and lead to dysphagia, but not polyphagia. Brittle nails may indicate peripheral artery disease. Loss of hair on legs is a symptom of peripheral artery disease. p. 810

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? Osteoporosis Aortic aneurysm Erectile dysfunction Human immunodeficiency virus (HIV) infection

Aortic aneurysm 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.

The nurse is caring for a patient with superficial vein thrombosis and expects what assessment findings? Tenderness to pressure over the involved vein Presence of edema with pain Induration of the overlying muscle Appearance of the vein as a palpable cord

Appearance of the vein as a palpable cord

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. Aspirin Gingko biloba Black cohosh Acetaminophen Foods containing vitamin K

Aspirin Gingko biloba Black cohosh

A patient is diagnosed with an abdominal aortic aneurysm. The patient undergoes minimally invasive aneurysm repair with an endovascular graft and returns to an inpatient room after the procedure. Which is the priority nursing action? Assess the groin area. Measure the abdominal girth. Determine when the patient last urinated. Ask the patient to rate pain on a 0 to 10 scale.

Assess the groin area The endovascular graft is placed through the femoral arteries to the area of the aneurysm to prevent further expansion. The nurse first should inspect the groin area, the femoral artery sites, for bleeding and hematoma. Measuring the abdominal girth, determining when the patient last urinated, and pain assessment are secondary in importance. p. 812

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? No routine laboratory monitoring is needed. Avoid contact sports and high-risk activities. Increase daily intake of dark leafy vegetables. Continue to use garlic as a dietary supplement.

Avoid contact sports and high-risk activities. 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. p. 820

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? Blockage of the graft Compartment syndrome Thoracic aortic aneurysms Superficial vein thrombosis

Blockage of the graft 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. p. 807

The nurse is performing a physical assessment on a patient with chronic venous insufficiency (CVI). Which manifestation involving the lower extremities should the nurse expect? Shiny skin Lack of sensation Brownish color Absent pulses

Brownish or "brawny" is the characteristic skin color of the lower leg in chronic venous insufficiency. The brownish skin discoloration occurs when the red blood cells leak from the capillaries, break down, and release hemosiderin. Shiny skin and absent pulses are manifestations of peripheral artery disease. Itching is a common report by the patients with CVI. p. 826

When taking a patient's history, the 40-year-old patient tells the nurse, "I have a condition that makes me have pain in my feet and arms sometimes. They change color and temperature, get tingly, and are sensitive to cold. I was told that the primary treatment is for me to stop smoking and using marijuana." The nurse suspects that the patient is referring to what disorder? Buerger's disease Venous thrombosis Acute arterial ischemia Raynaud's phenomenon

Buerger's disease is a nonatherosclerotic, segmental, recurrent inflammatory disorder of small and medium-sized vascular vessels of the upper and lower extremities, leading to color and temperature changes of the limbs, intermittent claudication, rest pain, and ischemic ulcerations. It primarily occurs in men younger than 45 years old with a long history of tobacco or marijuana use.

The nurse assesses that a patient with acute ascending aortic dissection has narrowed pulse pressure, jugular venous distention, and a diastolic blood pressure of 60 mm Hg. With what does the nurse correlate these findings? Cardiac tamponade Spinal cord ischemia Mesenteric ischemia Advanced-stage cancer

Cardiac tamponade The patient who has acute ascending aortic dissection is at high risk of cardiac tamponade. Narrow pulse pressure, jugular venous distention, and diastolic blood pressure of 60 mm Hg or hypotension are symptoms of cardiac tamponade. It occurs due to leakage of blood from the dissection into the pericardial sac.

Which sign or symptom is associated with acute dissection of the ascending aorta? Throbbing headache Pulsating substernal mass Chest pain described as ripping in nature Cyanotic toes with palpable dorsalis pedis pulses

Chest pain described as ripping in nature Dissection of the aorta occurs when a tear occurs in the intimal (inner) layer of the blood vessel and then blood flow separates the intimal and medial (middle) layers of the aorta. Chest pain that is ripping in nature occurs with dissection of the ascending aorta. The pain may radiate to the neck or shoulders but does not involve a throbbing headache. There is not a mass with the dissection as there may be with an aortic aneurysm. Emboli from thrombus in an abdominal aneurysm cause cyanotic toes with palpable pedal pulses. p. 815

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

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.

The nurse reviews the assessment findings of a patient with atherosclerosis and notes an ankle brachial index (ABI) of 0.8, decreased Doppler pressures, aspirin intolerance, and arterial stenosis. What is the best treatment choice? Nifedipine Clopidogrel Furosemide Doxycycline

Clopidogrel

The nurse reviews the medication profile of a patient and identifies that which type of medication predisposes the patient to thrombus formation? Antibiotics Corticosteroids β-adrenergic blockers Nonsteroidal antiinflammatory drugs (NSAIDs)

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.

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

Cryoplasty 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. p. 806

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? Tamoxifen Diclofenac Metoprolol Epoetin alfa

Diclofenac 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. p. 816

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 Echocardiography Computed tomography scan Magnetic resonance imaging

Electrocardiogram 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. p. 811

The nurse is providing postoperative care for a patient who underwent abdominal aortic repair surgery. Which parameter needs to be monitored continuously by the nurse? Electrocardiogram Ankle-brachial index Complete blood count Activated partial thromboplastin time

Electrocardiogram Electrocardiogram should be monitored continuously after aortic surgery to identify any cardiac problems. Ankle-brachial index, complete blood count, and activated partial thromboplastin time may not require continuous monitoring after aortic surgery. p. 813

A patient with acute aortic dissection is scheduled for a medication that will be titrated to maintain a target heart rate of 60 beats/minute or less. The nurse identifies that which medication will be given? Esmolol Clopidogrel Nadroparin Rivaroxaban

Esmolol Esmolol is a β-adrenergic blocker and is titrated to a target a heart rate of 60 beats/minute or less. Clopidogrel is recommended for peripheral artery disease. Nadroparin is used as an anticoagulant. Rivaroxaban is a factor Xa inhibitor and is used as an anticoagulant. p. 815

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? Diclofenac Tamoxifen Clopidogrel Furosemide

Furosemide 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.

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? Infection Graft occlusion Aneurysm rupture Raynaud's phenomenon

Graft occlusion

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

Heart failure 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. p. 805

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? Infection Buerger's disease Raynaud's phenomenon Peripheral artery disease

Infection

The nurse is assessing a patient who has peripheral artery disease (PAD). Which assessment finding is considered to be the gold standard in identifying lower extremity PAD? Rest pain Skin ulcerations Intermittent claudication Paresthesia in the feet and toes

Intermittent claudication which is ischemic muscle pain that is caused by exercise, resolves within 10 minutes or less with rest, and is reproducible

The nurse is assessing a patient with a saccular aneurysm. The nurse recalls what characteristic of this type of aneurysm? It is circumferential and relatively uniform in shape. It occurs due to peripheral artery bypass graft surgery. It involves formation of the aneurysm with at least one vessel layer still intact. It is pouchlike and has a narrow neck connecting the bulge to one side of the arterial wall.

It is pouchlike and has a narrow neck connecting the bulge to one side of the arterial wall.

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? Blood viscosity Triglycerides Lactic acid Homocysteine

Lactic acid 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. p. 803

A patient has undergone an endovascular aneurysm repair. The nurse should inform the patient that follow-up will include what test on a regular basis? Urinalysis White blood cell count Blood urea nitrogen levels Magnetic resonance imaging

Magnetic resonance imaging The magnetic resonance imaging study or CT is required to be performed regularly for rest of a patient's life after endovascular aneurysm repair to monitor for further complications.

Which diagnostic test can distinguish acute and chronic thrombus in a patient? Duplex ultrasound Contrast venography Venous compression ultrasound Magnetic resonance venography

Magnetic resonance venography Magnetic resonance venography involves the use of magnetic resonance imaging along with specialized software to evaluate blood flow through veins. This diagnostic test can identify acute and chronic thrombi. Duplex ultrasound is used to determine the location and extent of a thrombus. Contrast venography is used to determine the location and extent of a clot. Venous compression ultrasound is used to evaluate deep femoral, popliteal, and posterior tibial veins.

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? Cilostazol Nifedipine Acetaminophen Nicotine transdermal patch

Nicotine transdermal patch 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. p. 809

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

Parethesia 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. p. 808

Which patient is at high risk for developing irreversible renal failure after an aortic aneurysm surgery? The patient with diabetes The patient with spinal cord injury The patient with critical limb ischemia The patient with hyperhomocysteinemia

Patient with diabetes 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. p. 814

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

Pentoxifylline Pentoxifylline is used to treat intermittent claudication p. 805

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? Preoperative education about surgical repair The use of simvastatin to reduce the aneurysm The use of doxycycline to eliminate the aneurysm The use of hormonal therapy to reduce the aneurysm

Preoperative education about surgical repair 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. p. 811

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? Administer argatroban Measure ankle-brachial index Administer intravenous fluids and electrolytes Prepare for immediate surgical repair with simultaneous resuscitation

Prepare for immediate surgical repair with simultaneous resuscitation 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. p. 811

Which nursing action is beneficial for a patient who underwent an abdominal aortic aneurysm repair and develops endoleak? Administering furosemide to the patient Preparing the patient for coil embolization Instructing the patient to avoid spinach in the diet Instructing the patient to avoiding aspirin-containing drugs

Preparing the patient for coil embolization 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. p. 812

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? Administering metoprolol Preparing the patient for reoperation Preparing the patient for laser therapy Administering sodium nitroprusside

Preparing the patient for reoperation 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. p. 813

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? Diaphoresis Periumbilical pain Prolonged low blood pressure Elevated white blood cell count

Prolonged low blood pressure 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. p. 813

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? Bosentan Protamine Nifedipine Metoprolol

Protamine reverses the anticoagulant effects of dalteparin 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.

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

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. p. 808

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. Ramipril Iloprost Simvastatin Nifedipine Warfarin Argatroban

Ramipril Simvastatin 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). p. 805

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? Aortic aneurysm Raynaud's phenomenon Post-thrombotic syndrome Superficial vein thrombosis

Raynaud's phenomenon

Bluish fingers and toes, pallor, rubor, throbbing, and aching pain due to exposure to cold

Raynaud's phenomenon

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

Reduces hypertension 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. p. 805

The nurse reviews the treatment plan for a patient experiencing intraabdominal hypertension following an emergency repair of a ruptured abdominal aortic aneurysm (AAA). The nurse should question which item that is listed on the plan? Gastric decompression Temporary hemofiltration Cautious fluid resuscitation Reverse Trendelenburg position

Reverse Trendelenburg position Placing the patient's bed in the reverse Trendelenburg position will prevent edema by increasing perfusion to the lower extremities. Conservative measures to treat intraabdominal hypertension (IAH) include gastric decompression, temporary hemofiltration, and cautious fluid resuscitation.p. 812

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

Rivaroxaban 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. p. 820

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

Rotating the medication administration site frequently 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. p. 820

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? Osteoporosis Sexual dysfunction Raynaud's phenomenon Peripheral artery disease

Sexual Dysfunction 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. p. 814

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

Simvastatin 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. p. 805

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

Soaking the patient's feet to allow for thorough cleaning 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.

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

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. p. 806

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? Aortic aneurysm Raynaud's phenomenon Peripheral artery disease Superficial vein thrombosis

Superficial vein thrombosis 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. p. 818

The nurse suspects what reason that a patient is not responding well to clopidogrel therapy? The patient is eating low-sodium food. The patient is taking omeprazole medication. The patient is experiencing aspirin intolerance. The patient is experiencing peripheral artery disease.

The patient is taking omeprazole medication. 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.

A patient with diabetes undergoes an ankle-brachial index (ABI) test. The result of the test is 1.10. How should the nurse interpret the test result? The patient will be diagnosed with peripheral arterial disease (PAD). The patient has an abnormal ABI. The patient may have a falsely elevated ABI. The patient has borderline ABI.

The patient may have a falsely elevated ABI. ABI of 1.10 is a normal value in healthy adults. However, in diabetic patients the arteries are calcified and noncompressible, which often results in a falsely elevated ABI.

Assessment findings indicate graft occlusion in a patient who underwent repair of an aortic aneurysm. The nurse anticipates that the plan of care will include what treatment? Iloprost Hydralazine Gene therapy Thrombolytic therapy

Thrombolytic therapy Formation of a blood clot may result in graft occlusion. Thrombolytics digest the clot, so thrombolytic therapy is recommended for graft occlusion. Iloprost is used to treat critical limb ischemia. Hydralazine is used to treat hypertension. Gene therapy is used to stimulate angiogenesis. p. 814

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

To increase angiogenesis 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.

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

To increase perfusion to the lower extremities 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. p. 806

The nurse is caring for a patient who had insertion of a temporary lumbar drain after an endovascular dissection repair. What does the nurse explain to the patient that the benefit of the drain is? To reduce pain To prevent paralysis To prevent infection To stimulate angiogenesis

To prevent paralysis Repair of endovascular dissection may cause accumulation of cerebrospinal fluid, resulting in spinal cord edema. Temporary insertion of a lumbar drain helps remove the cerebrospinal fluid and reduce spinal cord edema, thus preventing paralysis. Analgesics are administered to reduce surgical pain. Antibiotics are administered to prevent infection. Gene therapy is used to stimulate angiogenesis. p. 815

The nurse is preparing a patient for an open aneurysm repair. What nursing actions can assist with decreasing the risk for bowel complications? Using the retroperitoneal surgical approach Administering labetalol to the patient after surgery Avoiding the administration of broad-spectrum antibiotics Removing the indwelling urinary catheter within a short time

Using the retroperitoneal surgical approach The retroperitoneal surgical approach should be used while performing open aneurysm repair because it minimizes the risk of bowel complications. Labetalol prevents hypertension after surgery. Broad-spectrum antibiotics should be administered to the patient to prevent systemic infections. Early removal of the indwelling urinary catheter reduces the chance of urinary tract infection. p. 813

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

Vitamin K

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? Vitamin K Cobalamin Heparin sodium Protamine sulfate

Vitamin K 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 B 12. Heparin sodium is not the antidote for warfarin. p. 820

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? Blue toe syndrome Intermittent claudication Epigastric discomfort Weakened carotid pulse

Weakened carotid pulse 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. p. 815

Altered bowel elimination, abdominal and chest pain are symptoms of

aortic aneurysm

involves the use of magnetic resonance imaging along with specialized software to evaluate blood flow through veins. This diagnostic test can identify acute and chronic thrombi

magnetic resonance venography

Presence of pain, tenderness, warmth, erythema, swelling, and a palpable cord at the catheter insertion site indicates

phlebitis

presence of an itchy, reddened, painful, and warm lower extremity, elevated body temperature characterizes

superficial vein thrombosis

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 High blood pressure Elevated blood sugar Dry, itchy, flaky skin

Rest pain occurs as PAD progresses and involves multiple arterial segments. Compression stockings are not indicated in the treatment plan for patients with PAD.

Ankle-brachial index for moderate peripheral artery disease

0.71 - 0.41

Ankle-brachial index for mild peripheral artery disease

0.90 - 0.71

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? "I need to call my health care provider if I have any foot problems." "I should gently clean the incision with mild soap and water, then dry it well." "I should wear clean, all-cotton or all-wool socks." "It is important to me to take daily walks."

"I should gently clean the incision with mild soap and water, then dry it well." 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. p. 808

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? "I should turn and position the patient frequently with pillows." "I should measure the ankle-brachial index 10 minutes after surgery." "I should instruct the patient to use elastic compression stockings daily." "I should instruct the patient to refrain from sitting with the legs dangling."

"I should measure the ankle-brachial index 10 minutes after 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. p. 807

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

"I will put on my stockings after I get out of bed each day." 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. p. 826

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? "I will not wear tight shoes." "I will soak my feet every evening." "I will make sure to apply lotion to my feet each day." "I will inspect my feet daily to look for skin cracking or sores."

"I will soak my feet every evening." 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. pp. 805-806

The registered nurse observes a new graduate nurse providing postoperative instructions to a patient with a history of cardiovascular disease. Which statement made by the new graduate nurse requires correction? "We will ambulate you in the halls four to six times a day." "It is important to flex and extend your hips, knees, and feet every eight hours." "You will need to wear an intermittent pneumatic compression device." "You will receive enoxaparin in your stomach twice a day until you are discharged."

"It is important to flex and extend your hips, knees, and feet every eight hours." measures listed are to prevent postoperative venous thromboembolism. Hips, knees, and feet should be flexed at least every two to four hours while awake. The other statements indicate adequate understanding. Ambulation should take place four to six times a day. The patient should wear the compression devices at all times unless bathing, walking, or during the skin assessment. Enoxaparin will be given subcutaneously to the abdomen twice a day until the patient is discharged.

A patient with varicose veins has been prescribed compression stockings. What information should the nurse provide to the patient? "Try to keep your stockings on 24 hours a day, as much as possible." "While you're still lying in bed in the morning, put on your stockings." "Dangle your feet at your bedside for 5 minutes before putting on your stockings." "Your stockings will be most effective if you can remove them for a few minutes several times a day."

"While you're still lying in bed in the morning, put on your stockings." The patient with varicose veins should apply stockings in bed, before rising in the morning. Stockings should not be worn continuously, but they should not be removed several times daily. Dangling feet at the bedside before application of stockings is likely to decrease their effectiveness. p. 826

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. 1. Advising the patient to maintain a body mass index (BMI) of less than 25 kg/m 2 2. Advising the patient to exercise daily 3. Advising the patient to maintain a waist circumference of less than 45 inches 4. Administering an antiplatelet agent 5. Administering an angiotensin-converting enzyme (ACE) inhibitor

1. Advising the patient to maintain a body mass index (BMI) of less than 25 kg/m 2 2. Advising the patient to exercise daily 4. Administering an antiplatelet agent 5. Administering an angiotensin-converting enzyme (ACE) inhibitor 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/m 2. 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. p. 805

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. Do not smoke or use any tobacco products. 3. Identify strategies to reduce emotional stress. 5. Do not use drugs that contain pseudoephedrine. 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. p. 810

A patient has prosthetic heart valves and is being treated with warfarin to prevent blood clots. Which dietary supplements should the nurse teach the patient to avoid? Select all that apply. 1. Fish oil 2. Melatonin 3. Garlic 4. Soy 5. Red yeast rice

1. Fish oil 2. Melatonin 3. Garlic Many dietary supplements may have adverse interactions with drugs and increase the risk of complications. Fish oil, melatonin, and garlic tend to increase the risk of bleeding and should be avoided in patients who are taking warfarin (Coumadin). Soy is used to treat high cholesterol. Red yeast rice is used to treat high cholesterol levels.

What interventions will decrease the likelihood of a patient developing varicose veins? Select all that apply. 1. Maintaining ideal body weight 2. Avoiding long periods of sitting 3. Taking 325 mg of aspirin daily 4. Applying hydrating lotions to the skin of legs daily 5. Avoiding standing for long periods

1. Maintaining ideal body weight 2. Avoiding long periods of sitting 5. Avoiding standing for long periods 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. p. 826

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. Monitor perfusion to the extremities 3. Encourage the patient to practice meticulous foot care 4. Teach the patient or caregiver about wound management 6. Report any potential complications, such as bleeding or thrombosis 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 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 O 2 source if supplemental O 2 is prescribed

1. Monitor platelet count. 3. Use small-gauge needle for venipunctures. 5. Humidify O 2 source if supplemental O 2 is prescribed - decreases risk of nosebleed

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. 1. Participate in supervised exercise training. 2. It is important to practice meticulous foot care. 3. Increase daily walking to 60 min/day. 4. Visit the health care provider for treatment of thick or overgrown toenails. 5. Wear pointed shoes with soft insoles.

1. Participate in supervised exercise training. 2. It is important to practice meticulous foot care. 4. Visit the health care provider for treatment of thick or overgrown toenails. The nurse should encourage supervised exercise training to improve a number of cardiovascular disease risk factors, including hypertension, hyperlipidemia, obesity, and glucose levels. Meticulous foot care is important to prevent infection, especially in a diabetic patient. Thick or overgrown toenails and calluses are potentially serious and require regular attention by a podiatrist. The patient should gradually increase walking to 30 to 40 min/day. The patient should be encouraged to wear comfortable shoes with rounded toes and soft insoles. p. 808

Which interventions should the nurse perform for conservative management of critical limb ischemia? Select all that apply. 1. Preventing infection 2. Decreasing ischemic pain 3. Improving blood perfusion 4. Recommending that the patient increase the intake of saturated fat 5. Recommending that the patient reduce the intake of foods high in zinc

1. Preventing infection 2. Decreasing ischemic pain 3. Improving blood perfusion Critical limb ischemia is due to severe blockage in the arteries of the lower extremities caused by reduced blood flow. Infection increases the risk of critical limb ischemia. The patient has ischemic pain during critical limb ischemic conditions. Poor blood perfusion to the extremities can increase the risk of critical limb ischemia. The nurse should instruct the patient to reduce saturated fat intake. The nurse should encourage the patient to increase foods high in zinc. p. 805

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. 1. The patient uses tobacco. 2. The patient takes an estrogen-based oral contraceptive. 3. The patient has been taking aspirin daily for 1 year. 4. The patient has a family history of VTE. 5. The patient lives in a high-altitude area.

1. The patient uses tobacco. 2. The patient takes an estrogen-based oral contraceptive. 4. The patient has a family history of VTE. 5. The patient lives in a high-altitude area. 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.

The nurse provides postoperative care for a patient and should monitor the patient for what indications of venous thromboembolism (VTE)? Select all that apply. 1. Venous distention 2. Vein appears as a palpable cord 3. Deep-reddish color over the affected area 4. Itchiness and warmth over the affected area 5. Tenderness with palpation

1. Venous distention 3. Deep-reddish color over the affected area 5. Tenderness with palpation Clinical findings for VTE include tenderness to pressure over involved vein, induration of overlying muscle, venous distention, edema, possible mild to moderate pain, and a deep reddish color to area caused by venous congestion. Itchiness and cordlike texture are characteristics of superficial venous thrombosis. p. 818

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

1.5 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

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. Increasing fresh fruit intake 3. Increasing foods high in Vitamin A 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. p. 808

The nurse is caring for a patient in the recovery area following a femoral-posterior tibial bypass graft. Which interventions should the nurse perform for the patient? Select all that apply. 1. Take ankle-brachial index (ABI) measurement 2. Obtain palpable pulses 3. Check sensation and movement 4. Inspect operative extremity every 15 minutes 5. Place the patient in a knee-flexed position

2. Obtain palpable pulses 3. Check sensation and movement 4. Inspect operative extremity every 15 minutes When caring for the patient in the recovery area, the nurse should obtain palpable pulses, check sensation and movement of extremities, and inspect the operative extremity every 15 minutes. Postoperative ABI measurements are not recommended because they place the patient at risk for graft thrombosis. In the recovery area, the patient is not placed in a knee-flexed position; this position is adopted only during exercise on post-op day one in the absence of complications. p. 807

The nurse provides discharge instructions to a patient who underwent femoral artery bypass surgery with synthetic graft replacement. The nurse instructs the patient to monitor for what indications of acute arterial ischemia? Select all that apply. 1. Pulse rate of 110 2. Pale and white leg 3. Severe pain in the lower leg 4. Oral temperature of 38.2º C 5. No hair growth on lower legs 6. Redness along the surgical incision

2. Pale and white leg 3. Severe pain in the lower leg "six Ps": pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (leg is the temperature of the environment or cooler)

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. Use a soft toothbrush and observe the gums for bleeding. 3. Wear a bracelet that identifies the patient is taking an anticoagulant. 5. Do not take ibuprofen (Motrin) or aspirin unless prescribed by the primary health care provider. 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. pp. 820, 824

The nurse reviews a patient's laboratory results before administering a prescribed dose of vitamin K 1. 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? 1.0 1.2 1.6 2.1

2.1 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 K 1. pp. 820-821

The nurse gives a patient with diabetes mellitus information 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. 1. "I should wear all-cotton socks." 2. "I should refrain from soaking my feet." 3. "I should have my capillary refill checked annually by my health care provider." 4. "I should inspect my feet daily for any mottling." 5. "I should wear nylon socks."

3. "I should have my capillary refill checked annually by my health care provider." 5. "I should wear nylon socks." The patient with diabetes mellitus is at high risk for developing peripheral artery disease. Having capillary refill checked annually by the provider is not frequent enough, so this is an incorrect statement. The patient must check capillary refill regularly to ensure proper blood circulation. The patient should not wear nylon socks because they will retain moisture close to the feet, which can lead to skin breakdown, so this is an incorrect statement. Wearing breathable socks, such as all-cotton, refraining from soaking the feet to prevent skin maceration, and inspecting feet daily for mottling will help prevent vascular complications. These statements, if made by the patient, indicate understanding of patient teaching. p. 808

The nurse understands that venous ulcers are characterized by which assessment findings? Select all that apply. 1. Bluish tinge of the extremities 2. Capillary refill greater than 3 seconds 3. Pain worse with leg in a dependent position 4. Well-defined edges along the ulcer 5. Located above the medial malleolus

3. Pain worse with leg in a dependent position 5. Located above the medial malleolus 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. p. 826

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. Take medication at the same time each day. 5. Contact emergency response services (ERS) if there is blood in the stool. 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 reviews the medical records of four patients and identifies that which patient is at risk for venous thromboembolism? A patient on hormone therapy A patient with hyperuricemia A patient receiving anticoagulant therapy as well as aspirin A patient with high C-reactive protein levels

A patient on hormone therapy 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. p. 817

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? Lymphatic obstruction Arterial insufficiency Venous insufficiency Musculoskeletal abnormalities

Arterial insufficiency 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. p. 804

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

Assist the patient with walking several times 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. p. 807

The nurse anticipates a prescription for which treatment for a patient who has undergone distal peripheral bypass surgery using synthetic graft material? Furosemide therapy for 3 days Propranolol therapy for 1 week Nitroprusside therapy for 1 month Clopidogrel plus aspirin therapy for 1 year

Clopidogrel plus aspirin therapy for 1 year 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. p. 807

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

Complete cessation of tobacco and marijuana use 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? Administer an oral anticoagulant Measure the ankle-brachial index Prepare for surgical revascularization Contact the health care provider

Contact HCP 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. p. 807

The nurse identifies that which treatment is beneficial for a patient with lower leg superficial vein thrombosis? Nifedipine Doxycycline Furosemide Fondaparinux

Fondaparinux Fondaparinux inhibits factor Xa and reduces thrombus formation; a prophylactic dose of fondaparinux is used to treat lower leg superficial vein thrombosis. Nifedipine is a calcium channel blocker used to reduce the severity of a vasospastic attack. Doxycycline is used to treat aortic aneurysms. Furosemide is a diuretic used to treat hypertension. p. 818

The nurse reviews the care options for patients with lower extremity peripheral artery disease (PAD). Which treatment is used to stimulate blood vessel growth? Urokinase Plasminogen activator Spinal cord stimulation Gene and stem cell therapy

Gene and stem cell therapy is used to stimulate blood vessel growth, or angiogenesis p. 806

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? Aspirin Iloprost Propranolol Hydralazine

Iloprost 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 is assessing a patient with Raynaud's phenomenon. What should the nurse teach the patient to prevent recurrent episodes? Wear thin, light clothing to allow better circulation. Drink small amounts of caffeine throughout the day to stimulate heartbeat and increase circulation. Immerse hands in warm water to decrease vasospasm and promote normal blood circulation. Use a cold compress or heating pad as needed for comfort.

Immerse hands in warm water to decrease vasospasm and promote normal blood circulation. Raynaud's phenomenon is triggered by stress and cold, and immersing hands in warm water often may decrease vasospasm. The patient should wear loose, warm clothing to protect from the cold, including gloves when handling cold objects. The patient should stop using all tobacco products and avoid caffeine and any drugs, such as cocaine, amphetamines, ergotamine, and pseudoephedrine, that have vasoconstrictive effects. The patient should avoid extreme temperatures at all times, so the use of a cold compress or heating pad would not be recommended. p. 810

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? Venous obstruction in the leg Claudication resulting from venous abnormalities Ischemia resulting from complete blockage of an artery Ischemia resulting from partial blockage of an artery

Ischemia resulting from partial blockage of an artery 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. p. 803

What is an appropriate nursing intervention for a patient following vein ligation surgery? Maintaining elastic compression stockings at all times Keeping the legs elevated at 15 degrees Reporting any bruising and discoloration Asking the patient to avoid deep breathing

Keeping the legs elevated at 15 degrees 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. p. 826

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

Leathery, brown-colored skin 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. p. 818

The nurse is caring for a patient with Buerger's disease and expects which clinical manifestation? Back pain when lying flat Chest pain when walking up stairs Leg pain with exercise and relief with rest Reddening of lower legs and feet when elevated

Leg pain with exercise and relief with rest 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.

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

Loss of hair on legs, feet, and toes 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 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? Osteoporosis Erectile dysfunction Gastrointestinal bleeding Venous thromboembolism

Osteoporosis 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. p. 821

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? The patient is experiencing side effects of heparin. The patient has Raynaud's phenomenon. The patient has venous disease. The patient has peripheral artery disease (PAD).

PAD 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. p. 804

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? Hematocrit (Hct) Hemoglobin (Hgb) Prothrombin time (PT) Partial thromboplastin time (PTT)

PT 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.

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? Cilostazol Bosentan Plasminogen activator Percutaneous transluminal angioplasty (PTA)

PTA 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. p. 805

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? Bosentan Paclitaxel Doxycycline Amphetamine

Paclitaxel 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. p. 806

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

Pain and swelling in the lower extremity 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. pp. 820-821

A patient takes ibuprofen and aspirin for management of peripheral artery disease (PAD). The nurse should instruct the patient to notify the health care provider (HCP) before taking which herbal supplement? Milk thistle St. John's wort Flaxseed Goldenseal

Patients taking antiplatelet agents, NSAIDs, and anticoagulants should consult with their HCP before taking any dietary or herbal supplements because of potential interactions and bleeding risks. Herbs and dietary supplements that may affect blood clotting include goldenseal. Milk thistle, St. John's wort, and flaxseed have not been identified as affecting blood clotting. pp. 805, 820

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

Supine 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. p. 807

What is the priority nursing intervention in the care of a patient with a diagnosis of chronic venous insufficiency (CVI)? Application of topical antibiotics to venous ulcers Maintaining the patient's legs in a dependent position Administering oral or subcutaneous anticoagulants Teaching the patient the correct use of compression stockings

Teaching the patient the correct use of compression stockings CVI requires conscientious and consistent application of compression stockings. Anticoagulants are not necessarily indicated and antibiotics, if required, are typically oral or intravenous, not topical. The patient should avoid prolonged positioning with the limb in a dependent position. p. 827

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? Monitoring for adverse effects of anticoagulant use Administering prescribed subcutaneous anticoagulants Providing instructions about the use of pressure to stop bleeding Teaching about the use of compression stockings during a hospital discharge

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. p. 824

The nurse is caring for a patient who has been treated for angina pectoris and underwent percutaneous transluminal angioplasty (PTA). What is the primary purpose of this procedure? To assess myocardial perfusion To determine peripheral vessel patency To improve cardiopulmonary blood flow To increase the diameter of the coronary arteries

To increase the diameter of the coronary arteries In percutaneous transluminal angioplasty (PTA) the diameter of an occluded or stenosed coronary artery is increased by inserting a balloon catheter, which is then inflated. The inflated balloon compresses the atherosclerosis, stretches the bore of the vessel, or both, resulting in the dilation. PTA is not used to assess myocardial perfusion or determine peripheral vessel patency. PTA indirectly improves cardiopulmonary blood flow in the sense that improved coronary artery blood flow increases cardiac function; however, this is not the primary purpose of PTA. p. 806

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)? Tobacco use Excess weight Sedentary lifestyle High blood pressure

Tobacco use

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? Duplex ultrasound Contrast venography Magnetic resonance venography Computed tomography venography

duplex ultrasound 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. p. 819

The nurse notes changes in a patient's assessment findings, including phlebitis at the patient's peripheral intravenous (IV) site. What action should the nurse take? Remove the patient's IV catheter Apply an ice pack directly to the affected area Decrease the IV rate to 20 to 30 mL/hr Administer prophylactic antibiotics

priority intervention for superficial phlebitis is removal of the offending IV catheter. Ice should never be placed directly against the skin. Decreasing the IV rate is insufficient. Antibiotics normally are not required. p. 816