Cardio - NCLEX Peripheral vascular disorders

The intensive care department nurse is calculating the total intake for a client diagnosed with hypertensive crisis. The client has received 880 mL of D5W, IVPB of 100 mL of 0.9% NS, 8 ounces of water, 4 ounces of milk, and 6 ounces of chicken broth. The client has had a urinary output of 1,480 mL. What is the total intake for this client? _______

1,520 mL total intake. The urinary output is not used in this calculation. The nurse must add up both intravenous fluids and oral fluids to obtain the total intake for this client: 880 + 100 = 980 IV fluids Oral fluids (1 ounce = 30 mL): 8 ounces × 30 mL = 240 mL, 4 ounces × 30 mL = 120 mL, 6 ounces × 30 mL = 180 mL 240 + 120 + 180 = 540 mL oral fluids Total intake is 980 + 540 = 1,520 mL.

A 45-year-old patient with chronic arterial disease has a brachial systolic blood pressure (SBP) of 132 mm Hg and an ankle SBP of 102 mm Hg. The ankle-brachial index is and indicates (mild/moderate/severe) arterial disease.

102 ÷ 132 = 0.77; mild

The nurse is completing a neurovascular assessment on the client with chronic venous insufficiency. What should be included in this assessment? Select all that apply. 1. Assess for paresthesia. 2. Assess for pedal pulses. 3. Assess for paralysis. 4. Assess for pallor. 5. Assess for paresthesia.

Answer: 1, 2, 3, 4, 5 1. The nurse should determine if the client has any numbness or tingling. 2. The nurse should determine if the client has pulses, the presence of which indicates there is no circulatory compromise. 3. The nurse should determine if the client can move the feet and legs. 4. The nurse should determine if the client's feet are pink or pale. 5. The nurse should assess the feet to determine if they are cold or warm.

The client tells the nurse that his cholesterol level is 240 mg/dL. Which action should the nurse implement? 1. Praise the client for having a normal cholesterol level. 2. Explain that the client needs to lower the cholesterol level. 3. Discuss dietary changes that could help increase the level. 4. Allow the client to ventilate feelings about the blood test result.

Answer: 2 1. The cholesterol level should be less than 200 mg/dL. 2. The client needs to be taught ways to lower the cholesterol level. 3. The client should be taught a low-fat, low-cholesterol diet to help lower the cholesterol level. 4. The nurse needs to discuss facts concern- ing the cholesterol level and teach the client. A therapeutic conversation would not be appropriate.

The nurse is caring for clients on a surgical floor. Which client should be assessed first? 1. The client who is four (4) day post-operative abdominal surgery and is complaining of left calf pain when ambulating. 2. The client who is one (1) day post-operative hernia repair who has just been able to void 550 mL of clear amber urine. 3. The client who is five (5) day post-operative open cholecystectomy who has a T tube and is being discharged. 4. The client who is 16 hours post-abdominal hysterectomy and is complaining of abdominal pain and is expelling flatus.

Answer: 1 1. A complication of immobility after surgery is developing a DVT. This client with left calf pain should be assessed for a DVT. 2. This is an expected finding. 3. Clients who require an open cholecystectomy frequently are discharged with a T tube. This client needs to know how to care for the tube before leaving, but this is not a priority over a possible surgical complication. 4. This is expected for this client.

The nurse is teaching a class on coronary artery disease. Which modifiable risk factor should the nurse discuss when teaching about atherosclerosis? 1. Stress. 2. Age. 3. Gender. 4. Family history.

Answer: 1 1. A modifiable risk factor is a risk factor that can possibly be altered by modify- ing or changing behavior, such as de- veloping new ways to deal with stress. 2. The client cannot do anything about getting older, so it cannot be modified. 3. Gender is a risk factor that cannot be changed. 4. Having a family history of coronary artery disease predisposes the client to a higher risk, but this cannot be changed by the client.

The nurse is discussing the pathophysiology of atherosclerosis with a client who has a normal high-density lipoprotein (HDL) level. Which information should the nurse discuss with the client concerning HDL? 1. A normal HDL is good because it has a protective action in the body. 2. HDL lipoprotein level measures the free fatty acids and glycerol in the blood. 3. HDLs are the primary transporters of cholesterol into the cell. 4. The client needs to decrease the amount of cholesterol and fat in the diet.

Answer: 1 1. A normal HDL level is good because HDL transports cholesterol away from the tissues and cells of the arterial wall to the liver for excretion. This helps decrease the development of atherosclerosis. 2. The normal HDL level was the result of a test measuring high-density lipoproteins, not free fatty acids and glycerol in the blood, which are measured by the serum triglyceride level. Triglycerides are a source of energy. 3. Low-density lipoproteins (LDLs), not HDLs, are the primary transporters of cholesterol into the cell. They have the harmful effect of depositing cholesterol into the walls of the arterial vessels. 4. A normal HDL level is good and the client does not need to change the diet.

Which assessment data would warrant immediate intervention by the nurse? 1. The client diagnosed with DVT who complains of pain on inspiration. 2. The immobile client has refused to turn for the last three (3) hours. 3. The client who has had an open cholecystectomy does not want to breathe deeply. 4. The client who has had an inguinal hernia repair who must void before discharge.

Answer: 1 1. A potentially life-threatening complication of DVT is a pulmonary embolus, which causes chest pain. The nurse should determine if the client has "thrown" a pulmonary embolus. 2. An immobile client should be turned at least every two (2) hours, but a pressure area is not life threatening. 3. This is expected in a client who has a large upper abdominal incision. It hurts to breathe deeply. The nurse should address this but has some time. The life-threatening complication is priority. 4. Clients who have had inguinal hernia repair often have difficulty voiding afterward. This is expected.

The nurse is unable to assess a pedal pulse in the client diagnosed with arterial occlusive disease. Which intervention should the nurse implement first? 1. Complete a neurovascular assessment. 2. Use the Doppler device. 3. Instruct the client to hang the feet off the side of the bed. 4. Wrap the legs in a blanket.

Answer: 1 1. An absent pulse is not uncommon in a client diagnosed with arterial occlusive disease, but the nurse must ensure that the feet can be moved and are warm, which indicates adequate blood supply to the feet. 2. To identify the location of the pulse, the nurse should use a Doppler device to amplify the sound, but it is not the first intervention. 3. This position will increase blood flow and may help the nurse palpate the pulse, but it is not the first intervention. 4. Cold can cause vasoconstriction and decrease the ability to palpate the pulse, and warming will dilate the arteries, help- ing the nurse find the pedal pulse, but it is not the first intervention.

Which assessment data would require immediate intervention by the nurse for the client who is six (6) hours postoperative abdominal aortic aneurysm repair? 1. Absent bilateral pedal pulses. 2. Complaints of pain at the site of the incision. 3. Distended, tender abdomen. 4. An elevated temperature of 100 ̊F.

Answer: 1 1. Any neurovascular abnormality in the client's lower extremities indicates the graft is occluded or possibly bleeding and requires immediate intervention by the nurse. 2. The nurse would expect the client to have incisional pain six (6) hours after surgery, so this is not priority over a complication. 3. The nurse would expect the client to have a distended, tender abdomen as a result of postoperative edema. 4. A slightly elevated temperature would not be uncommon in a client who has had surgery.

The client had an abdominal aortic aneurysm repair two (2) days ago. Which inter- vention should the nurse implement first? 1. Assess the client's bowel sounds. 2. Administer an IV prophylactic antibiotic. 3. Encourage the client to splint the incision. 4. Ambulate the client in the room with assistance.

Answer: 1 1. Assessment is the first part of the nurs- ing process and is the first intervention the nurse should implement. 2. Administering an antibiotic is an appropri- ate intervention, but it is not priority over assessment. 3. The client should splint the incision when coughing and deep breathing to help decrease the pain, but this interven- tion is not priority over assessment. 4. Ambulating the client as soon as possible is an appropriate intervention to help decrease complications from immobility, but it is not priority over assessment.

The nurse is discussing the importance of exercising with a client who is diagnosed with CAD. Which statement best describes the scientific rationale for encouraging 30 minutes of walking daily to help prevent complications of atherosclerosis? 1. Exercise promotes the development of collateral circulation. 2. Isometric exercises help develop the client's muscle mass. 3. Daily exercise helps prevent plaque from developing in the vessel. 4. Isotonic exercises promote the transport of glucose into the cell.

Answer: 1 1. Collateral circulation is the develop- ment of blood supply around narrowed arteries; it helps prevent complications of atherosclerosis, including myocardial infarction, cerebrovascular accidents, and peripheral vascular disease. Exer- cise promotes the development of collateral circulation. 2. Isometric (weight-lifting) exercises help develop muscle mass, but this type of exercise does not help decrease complications of atherosclerosis. 3. A low-fat, low-cholesterol diet may help decrease the plaque formation, but exercise will not do this. 4. Isotonic exercises, such as walking and swimming, promote the movement of glucose across the cell membrane, but this is not why such exercises are recom- mended for prevention of atherosclerotic complications.

The client diagnosed with essential hypertension asks the nurse, "I don't know why the doctor is worried about my blood pressure. I feel just great." Which statement by the nurse would be the most appropriate response? 1. "Damage can be occurring to your heart and kidneys even if you feel great." 2. "Unless you have a headache, your blood pressure is probably within normal limits." 3. "When is the last time you saw your doctor? Does he know you are feeling great?" 4. "Your blood pressure reflects how well your heart is working."

Answer: 1 1. Even if the client feels great, the blood pressure can be elevated, causing dam- age to the heart, kidney, and blood vessels. 2. A headache may indicate an elevated blood pressure, but the client with essential hy- pertension can be asymptomatic and still have a very high blood pressure reading. 3. This response does not answer the client's question as to why the doctor is worried about the client's blood pressure. 4. The blood pressure does not necessarily reflect how well the heart is working. Many other diagnostic tests assess how well the heart is working, including an electrocardiogram (ECG), an ultrasound, and a chest x-ray.

The client is admitted for surgical repair of an 8-cm abdominal aortic aneurysm. Which sign/symptom would make the nurse suspect the client has an expanding AAA? 1. Complaints of low back pain. 2. Weakened radial pulses. 3. Decreased urine output. 4. Increased abdominal girth.

Answer: 1 1. Low back pain is present because of the pressure of the aneurysm on the lumbar nerves; this is a serious symp- tom, usually indicating that the aneurysm is expanding rapidly and about to rupture. 2. If any pulses were affected, it would be the pedal pulses, not the radial pulses. 3. Decreased urine output would not indi- cate an expanding AAA, but decreased urine output may occur when the AAA ruptures, causing hypovolemia. 4. The abdominal girth would not increase for an expanding AAA, but it might in- crease with a ruptured AAA.

The nurse is discussing discharge teaching with the client who is three (3) days post- operative abdominal aortic aneurysm repair. Which discharge instructions should the nurse include when teaching the client? 1. Notify HCP of any redness or irritation of the incision. 2. Do not lift anything that weighs more than 20 pounds. 3. Inform client there may be pain not relieved with pain medication. 4. Stress the importance of having daily bowel movements.

Answer: 1 1. Redness or irritation of the incision indicates infection and should be reported immediately to the HCP. 2. The client should not lift anything heavier than five (5) pounds because it may cause dehiscence or evisceration of the bowel. 3. The pain medication should keep the client comfortable; if it doesn't, the client should call the HCP. 4. Some clients do not have daily bowel movements, but the nurse should instruct the client not to allow himself or herself to become constipated, which will increase pressure on the incision.

The unlicensed nursing assistant is caring for the client diagnosed with chronic venous insufficiency. Which action would warrant immediate intervention from the nurse? 1. Applying compression stockings before going to bed. 2. Taking the client's blood pressure manually. 3. Assisting the client by opening the milk on the tray. 4. Calculating the client's shift intake and output.

Answer: 1 1. Research shows that removing the compression stockings while the client is in bed promotes perfusion of the subcutaneous tissue. The foot of the bed should be elevated. 2. The assistant can take the blood pressure with a machine or manually; therefore, the nurse would not need to intervene. 3. The assistant can help the client with meals as long as the client is stable. 4. The assistant can calculate the intake and output, but the nurse must evaluate the data to determine if they are normal for the client.

The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands teaching concerning the DASH diet? 1. "I should eat at least four (4) to five (5) servings of vegetables a day." 2. "I should eat meat that has a lot of white streaks in it." 3. "I should drink no more than two (2) glasses of whole milk a day." 4. "I should decrease my grain intake to no more than twice a week."

Answer: 1 1. The DASH diet has proved beneficial in lowering blood pressure. It recommends eating a diet high in vegetables and fruits. 2. The DASH diet recommends two (2) or fewer servings of lean meats, which have very few white streaks; the white streaks indicate the meat is high in fat. 3. The DASH diet recommends two (2) to three (3) servings of nonfat or low-fat milk, not whole milk. 4. The DASH diet recommends seven (7) to eight (8) servings of grain a day.

Which client problem would be priority in a client diagnosed with arterial occlusive disease who is admitted to the hospital with a foot ulcer? 1. Impaired skin integrity. 2. Activity intolerance. 3. Ineffective health maintenance. 4. Risk for peripheral neuropathy.

Answer: 1 1. The client has a foot ulcer; therefore, the protective lining of the body—the skin—has been impaired. 2. This is an appropriate problem, but would not take priority over impaired skin integrity. 3. The client needs teaching, but it does not take priority over a physiological problem. 4. The client has peripheral neuropathy, not a risk for it; this is the primary pathological change in a client with arterial occlusive disease.

The nurse is assessing the client diagnosed with long-term arterial occlusive disease. Which assessment data support the diagnosis? 1. Hairless skin on the legs. 2. Brittle, flaky toenails. 3. Petechiae on the soles of feet. 4. Nonpitting ankle edema.

Answer: 1 1. The decreased oxygen over time causes the loss of hair on the tops of the feet and ascending both legs. 2. The toenails are usually thickened due to hypoxemia. 3. Petechiae are tiny purple or red spots that appear on the skin as a result of minute hemorrhages within the dermal layer; this does not occur with arterial occlusive disease. 4. There may be edema but it is usually pitting; nonpitting edema resolves with elevation, but not in clients with arterial occlusive disease.

Which assessment data would support that the client has a venous stasis ulcer? 1. Superficial pink open area on the medial part of the ankle. 2. A deep pale open area over the top side of the foot. 3. A reddened blistered area on the heel of the foot. 4. A necrotic gangrenous area on the dorsal side of the foot.

Answer: 1 1. The medial part of the ankle usually ulcerates because of edema that leads to stasis, which, in turn, causes the skin to break down. 2. A deep, pale, open area over the top side of the foot describes an arterial ulcer. 3. A reddened blistered area on the heel describes a blister that may result from wearing shoes that are too tight or that rub on the heel. 4. Gangrene does not usually occur with venous problems; it occurs with arterial ulcers.

Which health-care provider's order should the nurse question in a client diagnosed with an expanding abdominal aortic aneurysm who is scheduled for surgery in the morning? 1. Type and crossmatch for two (2) units of blood. 2. Tap water enema until clear fecal return. 3. Bedrest with bathroom privileges. 4. Keep NPO after midnight.

Answer: 2 1. The client is at risk for bleeding; therefore, this order would not be questioned. 2. Increased pressure in the abdomen secondary to a tap water enema could cause the AAA to rupture. 3. The client should be able to ambulate to the bathroom without any problems. 4. Clients are NPO prior to surgery to help prevent aspiration or problems from general anesthesia.

The client diagnosed with a DVT is on a heparin (an anticoagulant) drip at 1400 units per hour, and Coumadin (warfarin sodium; also an anticoagulant) 5 mg twice a day. Which intervention should the nurse implement first? 1. Check the PTT and PT/INR. 2. Check with the HCP to see which drug should be discontinued. 3. Administer both medications. 4. Discontinue the heparin because the client is receiving Coumadin.

Answer: 1 1. The nurse should check the laboratory values pertaining to the medications before administering the medications. 2. The client will be administered an oral medication while still receiving a heparin drip to allow time for the client to achieve a therapeutic level of the oral medication before discontinuing the heparin. The effects of oral medications take three (3) to five (5) days to become therapeutic. 3. The laboratory values should be noted before administering the medications. 4. The heparin will be continued for three (3) to five (5) days before being discontinued.

The client with varicose veins asks the nurse, "What caused me to have these?" Which statement by the nurse would be most appropriate? 1. "You have incompetent valves in your legs." 2. "Your legs have decreased oxygen to the muscle." 3. "There is an obstruction in the saphenous vein." 4. "Your blood is thick and can't circulate properly."

Answer: 1 1. Varicose veins are irregular, tortuous veins with incompetent valves that do not allow the venous blood to ascend the saphenous vein. 2. Decreased oxygen to the muscle occurs with arterial occlusive disease. 3. This is the explanation for a deep vein thrombosis. 4. Thick, poorly circulating blood could be an explanation for diabetic neuropathy.

Which client would be most at risk for developing varicose veins? 1. A Caucasian female who is a nurse. 2. An African American male who is a bus driver. 3. An Asian female with no children. 4. An elderly male with diabetes.

Answer: 1 1. Varicose veins are more common in white females in occupations that involve prolonged standing. 2. Driving a bus does not require prolonged standing, which is a risk factor for developing varicose veins. 3. Studies suggest that the increased risk for varicose veins is common and may be the result of venous stasis during pregnancy. 4. Diabetes may lead to diabetic neuropathy and arterial occlusive disease, but it does not lead to varicose veins.

The nurse is teaching the client recently diagnosed with essential hypertension. Which instruction should the nurse provide when discussing exercise? 1. Walk at least 30 minutes a day on flat surfaces. 2. Perform light weight lifting three (3) times a week. 3. Recommend high-level aerobics daily. 4. Encourage the client to swim laps once a week.

Answer: 1 1. Walking 30 to 45 minutes a day will help to reduce blood pressure, weight, and stress and will increase a feeling of overall well-being. 2. Isometric exercises (such as weight lifting) should be discouraged because performing them can raise the systolic blood pressure. 3. The client should walk, cycle, jog, or swim daily, but high-level aerobic exercise may increase the client's blood pressure. 4. Swimming laps is recommended, but it should be daily, not once a week.

Which medical treatment would be prescribed for the client with an AAA less than 3 cm? 1. Ultrasound every six (6) months. 2. Intravenous pyelogram yearly. 3. Assessment of abdominal girth monthly. 4. Repair of abdominal aortic aneurysm.

Answer: 1 1. When the aneurysm is small (<5 to 6 cm), an abdominal sonogram will be done every six (6) months until the aneurysm reaches a size at which surgery to prevent rupture is of more benefit than possible complications of an abdominal aortic aneurysm repair. 2. An intravenous pyelogram evaluates the kidney. 3. The abdomen will not distend as the AAA enlarges. 4. This AAA is too small to perform surgery to remove it.

Which interventions should the nurse discuss with the client diagnosed with atherosclerosis? Select all that apply. 1. Include the significant other in the discussion. 2. Stop smoking or using any type of tobacco products. 3. Maintain a sedentary lifestyle as much as possible. 4. Avoid stressful situations. 5. Daily isometric exercises are important.

Answer: 1, 2 1. Adherence to lifestyle modifications is enhanced when the client receives support from significant others. 2. Tobacco use is the most significant modifiable risk factor that contributes to the development of atherosclerosis. 3. A sedentary lifestyle should be discouraged; daily walking or swimming is encouraged. 4. This is an unrealistic intervention. The nurse needs to help the client learn ways to deal with stressful situations, not avoid the situations. 5. Isometric exercises are weight-lifting exercises, which should be discouraged; isotonic exercises, such as walking or swimming, are encouraged.

The client is diagnosed with a small abdominal aortic aneurysm. Which interven- tions should be included in the discharge teaching? Select all that apply. 1. Tell the client to exercise three (3) times a week for 30 minutes. 2. Encourage the client to eat a low-fat, low-cholesterol diet. 3. Instruct the client to decrease tobacco use. 4. Discuss the importance of losing weight with the client. 5. Teach the client to wear a truss at all times.

Answer: 1, 2, 4 1. The most common cause of AAA is atherosclerosis, so teaching should address this area. 2. A low-fat, low-cholesterol diet will help decrease development of atherosclerosis. 3. The client should not decrease tobacco use—he or she must quit totally. Smoking is the one modifiable risk factor that is not negotiable. 4. Losing weight will help decrease the pressure on the AAA and will help address decreasing the cholesterol level. 5. A truss is worn by a client with a hernia, not an AAA.

The nurse is teaching the client diagnosed with arterial occlusive disease. Which interventions should the nurse include in the teaching? Select all that apply. 1. Wash legs and feet daily in warm water. 2. Apply moisturizing cream to feet. 3. Buy shoes in the morning hours only. 4. Do not wear any type of knee stocking. 5. Wear clean white cotton socks.

Answer: 1, 2, 4, 5 1. Cold water causes vasoconstriction and hot water may burn the client's feet; therefore, warm (tepid) water should be recommended. 2. Moisturizing prevents drying of the feet. 3. Shoes should be purchased in the afternoon when the feet are the largest. 4. This will further decrease circulation to the legs. 5. Colored socks have dye, and dirty socks may cause foot irritation that may lead to breaks in the skin.

On which area would the nurse place the bell of the stethoscope when assessing the client with an abdominal aortic aneurysm? 1. right upper quadrant 2. left upper quadrant 3. left lower quadrant 4. Midline above the umbilicus

Answer: 1. 1. Organs in the right upper quadrant include the liver and gallbladder. 2. Organs in the left upper quadrant include the stomach, pancreas, and spleen. 3. Organs in the left lower quadrant are the colon and ovaries in females. 4. The aorta transverses the abdomen in the midline position and that is the best location to hear an abdominal bruit. The bell should be placed midline above the umbilicus to best auscultate an abdominal bruit

The client with varicose veins is six (6) hours post-operative vein ligation. Which nursing intervention should the nurse implement first? 1. Assist the client to dangle the legs off the side of the bed. 2. Assess and maintain pressure bandages on the affected leg. 3. Apply a sequential compression device to the affected leg. 4. Administer the prescribed prophylactic intravenous antibiotic.

Answer: 2 1. Because the saphenous vein is removed during vein ligation, standing and sitting are prohibited during the initial recovery period to prevent increased pressure in the lower extremities. 2. Pressure bandages are applied for up to six (6) weeks after vein ligation to help prevent bleeding and to help venous return from the lower extremities when in the standing or sitting position. 3. Sequential compression devices are used to help prevent deep vein thrombosis. 4. Antibiotics would be ordered prophylactically for surgery, but it is not the first intervention.

Which actions should the surgical scrub nurse take to prevent from personally developing a DVT? 1. Keep the legs in a dependent position and stand as still as possible. 2. Flex the leg muscles and change the leg positions frequently. 3. Wear white socks and shoes that have a wedge heel. 4. Ask the surgeon to allow the nurse to take a break midway through each surgery.

Answer: 2 1. Keeping the legs dependent and standing still will promote the development of a DVT. 2. Flexing the leg muscles and changing positions assist the blood to return to the heart and move out of the peripheral vessels. 3. The nurse should wear support stockings, not socks, and change the types of shoes worn from day to day, varying the type of heels. 4. This is not in the client's best interest.

The client diagnosed with essential hypertension is taking a loop diuretic daily. Which assessment data would require immediate intervention by the nurse? 1. The telemetry reads normal sinus rhythm. 2. The client has a weight gain of 2 kg within 1 to 2 days. 3. The client's blood pressure is 148/92. 4. The client's serum potassium level is 4.5 mEq.

Answer: 2 1. Normal sinus rhythm indicates that the client's heart is working normally. 2. Rapid weight gain—for example, 2 kg in one (1) to two (2) days—indicates that the loop diuretic is not working effec- tively; 2 kg equals 4.4 lbs; 1 L of fluid weighs l kg. 3. This blood pressure is not life-threateningly high and does not require immediate intervention. 4. Loop diuretics cause an increase in potas- sium excretion in the urine; therefore, the potassium level should be assessed, but 4.5 mEq/L is within normal limits (3.5 to 5.5 mEq/L).

The client comes to the clinic complaining of muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client's record? 1. Peripheral vascular disease. 2. Intermittent claudication. 3. Deep vein thrombosis. 4. Dependent rubor.

Answer: 2 1. Peripheral vascular disease is a broad term that encompasses both venous and arterial peripheral problems of the lower extremities. 2. This is the classic symptom of arterial occlusive disease. 3. This is characterized by calf tenderness, calf edema, and a positive Homans' sign. 4. This term is a sign of arterial occlusive disease; the legs are pale when elevated but are dark red when in the dependent position.

The nurse is teaching a class on arterial essential hypertension. Which modifiable risk factors would the nurse include when preparing this presentation? 1. Include information on retinopathy and nephropathy. 2. Discuss sedentary lifestyle and smoking cessation. 3. Include discussions on family history and gender. 4. Provide information on a low-fiber and high-salt diet.

Answer: 2 1. Retinopathy and nephropathy are compli- cations of uncontrolled hypertension, not modifiable risk factors. 2. Sedentary lifestyle is discouraged in clients with hypertension; daily isotonic exercises are recommended. Smoking (cigars have problems too) increases the atherosclerotic process in vessels; causes vasoconstriction of vessels; and adheres to hemoglobin, decreasing oxygen levels. 3. Family history and gender are nonmodifi- able risk factors. The question is asking for information on modifiable risk factors. 4. A low-salt diet is recommended because increased salt intake causes water reten- tion, which increases the workload of the heart. A high-fiber diet is recommended because it helps decrease cholesterol levels.

Which assessment data would the nurse recognize to support the diagnosis of abdominal aortic aneurysm (AAA)? 1. Shortness of breath. 2. Abdominal bruit. 3. Ripping abdominal pain. 4. Decreased urinary output.

Answer: 2 1. Shortness of breath indicates a respiratory problem or possible a thoracic aneurysm, not an AAA. 2. A systolic bruit over the abdomen is a diagnostic indication of an AAA. 3. Ripping or tearing pain indicates a dissect- ing aneurysm. 4. Urine output is not diagnostic of an AAA.

The nurse is caring for clients on a telemetry floor. Which nursing task would be most appropriate to delegate to an unlicensed assistive personnel (UAP)? 1. Teach the client how to perform a glucometer check. 2. Assist feeding the client diagnosed with congestive heart failure. 3. Check the cholesterol level for the client diagnosed with atherosclerosis. 4. Assist the nurse to check the unit of blood at the client's bedside.

Answer: 2 1. Teaching cannot be delegated to a UAP. 2. The UAP can feed a client. 3. The UAP cannot assess the client and does not have the education to interpret laboratory data. 4. A unit of blood must be checked by two (2) registered nurses at the bedside.

The nurse is caring for the client with chronic venous insufficiency. Which statement indicates that the client understands the discharge teaching? 1. "I shouldn't cross my legs for more than 15 minutes." 2. "I need to elevate the foot of my bed while sleeping." 3. "I should take a baby aspirin every day with food." 4. "I should increase my fluid intake to 3000 mL a day."

Answer: 2 1. The client should not cross legs at all because this further impedes the blood from ascending the saphenous vein. 2. Elevating the foot of the bed while sleeping helps the venous blood return to the heart and decreases pressure in the lower extremity. 3. Antiplatelet therapy is for arterial blood, not venous blood. 4. Fluid intake will not help prevent or improve chronic venous insufficiency

The client is one (1) day postoperative abdominal aortic aneurysm repair. Which information from the unlicensed assistive personnel (UAP) would require immediate intervention from the nurse? 1. The client refuses to turn from the back to the side. 2. The client's urinary output is 90 mL in six (6) hours. 3. The client wants to sit on the side of the bed. 4. The client's vital signs are T 98, P 90, R 18, and BP 130/70.

Answer: 2 1. The nurse needs to intervene, but it does not require immediate intervention. 2. The client must have 30 mL of urinary output every hour. Clients who are post-AAA are at high risk for renal failure because of the anatomical location of the AAA near the renal arteries. 3. The client can sit on the bed the first day postoperation; this is, in fact, encouraged. 4. These vital signs would not warrant immediate intervention by the nurse.

The 80-year-old client is being discharged home after having surgery to debride a chronic venous ulcer on the right ankle. Which referral would be most appropriate for the client? 1. Occupational therapist. 2. Social worker. 3. Physical therapist. 4. Cardiac rehabilitation.

Answer: 2 1. The occupational therapist assists the client with activities of daily living skills, such as eating, bathing, or brushing teeth. 2. The social worker would assess the client to determine if home health care services or financial interventions were appropriate for the client. The client is elderly, immobility is a concern, and wound care must be a concern when the client is discharged home. 3. The physical therapist addresses gait training and transferring. 4. Cardiac rehabilitation helps clients who have had myocardial infarctions, cardiac bypass surgery, or congestive heart failure recover.

The wife of a client with arterial occlusive disease tells the nurse, "My husband says he is having rest pain. What does that mean?" Which statement by the nurse would be most appropriate? 1. "It describes the type of pain he has when he stops walking." 2. "His legs are deprived of oxygen during periods of inactivity." 3. "You are concerned that your husband is having rest pain." 4. "This term is used to support that his condition is getting better."

Answer: 2 1. The pain stops when the client quits walking; therefore, it is not rest pain. 2. Rest pain indicates a worsening of the arterial occlusive disease; the muscles of the legs are not getting enough oxygen when the client is resting to prevent muscle ischemia. 3. This is a therapeutic response and does not answer the wife's question. 4. Rest pain indicates that the arterial occlusive disease is getting worse.

The nurse is administering a beta blocker to the client diagnosed with essential hypertension. Which intervention should the nurse implement? 1. Notify the health-care provider if the potassium level is 3.8 mEq. 2. Question administering the medication if the BP is <90/60 mm Hg. 3. Do not administer the medication if the client's radial pulse is >100. 4. Monitor the client's BP while he or she is lying, standing, and sitting.

Answer: 2 1. The potassium level is within normal limits (3.5 to 5.5 mEq/L), and it is not usually checked prior to administering beta blockers. 2. The nurse should question administering the beta blocker if the BP is low because this medication will cause the blood pressure to drop even lower, leading to hypotension. 3. The nurse would not administer the med- ication if the apical (not radial) pulse were less than 60 beats per minute. 4. The nurse needs to assess the blood pressure only once prior to administering the medica- tion (not take all three blood pressures prior to administering the medication).

The 66-year-old male client has his blood pressure (BP) checked at a health fair. The BP is 168/98. Which action should the nurse implement first? 1. Recommend that the client have his blood pressure checked in one (1) month. 2. Instruct the client to see his health-care provider as soon as possible. 3. Discuss the importance of eating a low-salt, low-fat, low-cholesterol diet. 4. Explain that this BP is within the normal range for an elderly person.

Answer: 2 1. This BP is elevated, and the client should have his BP checked frequently but not before seeking medical treatment. 2. The diastolic blood pressure should be less than 85 mm Hg according to the American Heart Association; therefore, this client should see the health-care provider. 3. Teaching is important, but the nurse must first make sure the client sees the health- care provider for a thorough checkup and antihypertensive medication prescription. Diet alone should not be recommended by the nurse. 4. This is not the normal range for an elderly person's blood pressure; the diastolic should be less than 85 mm Hg.

The nurse just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with coronary artery disease who has a BP of 170/100. 2. The client diagnosed with deep vein thrombosis who is complaining of chest pain. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 98%. 4. The client diagnosed with ulcerative colitis who has nonbloody diarrhea.

Answer: 2 1. This blood pressure is elevated, but it is not life threatening. 2. The chest pain could be a pulmonary embolus secondary to deep vein thrombosis and requires immediate intervention by the nurse. 3. A pulse oximeter reading of greater than 93% is within normal limits. 4. Nonbloody diarrhea is an expected sign of ulcerative colitis and would not require immediate intervention by the nurse.

The nurse and an unlicensed nursing assistant are bathing a bedfast client. Which action by the assistant warrants immediate intervention? 1. The assistant closes the door and cubicle curtain before undressing the client. 2. The assistant begins to massage and rub lotion into the client's calf. 3. The assistant tests the temperature of the water with the wrist before starting. 4. The assistant collects all the linens and supplies and brings them to the room.

Answer: 2 1. This protects the client's privacy. 2. The assistant could dislodge a blood clot in the leg when massaging the calf. The assistant can apply lotion gently, being sure not to massage the leg. 3. Testing the temperature of the water prevents scalding the client with water that is too hot or making the client uncomfortable with water that is too cold. 4. Collecting supplies needed before beginning the bath is using time wisely and avoids interrupting the bath to go and get items needed.

The client is diagnosed with an abdominal aortic aneurysm. Which statement would the nurse expect the client to make during the admission assessment? 1. "I have stomach pain every time I eat a big, heavy meal." 2. "I don't have any abdominal pain or any type of problems." 3. "I have periodic episodes of constipation and then diarrhea." 4. "I belch a lot, especially when I lay down after eating."

Answer: 2 1. This statement would not make the nurse suspect an AAA. 2. Only about two-fifths of clients with AAA have symptoms; the remainder are asymptomatic. 3. Periodic episodes of constipation and diarrhea may indicate colon cancer but do not support a diagnosis of AAA. 4. Belching does not support a diagnosis of AAA, but it could possibly indicate gastroesophageal reflux or a hiatal hernia.

The HCP prescribes an HMG-CoA reductase inhibitor (statin) medication to a client with CAD. Which should the nurse teach the client about this medication? 1. Take this medication on an empty stomach. 2. This medication should be taken in the evening. 3. Do not be concerned if muscle pain occurs. 4. Check your cholesterol level daily.

Answer: 2 1.A statin medication can be taken with food or on an empty stomach. 2. Statin medications should be taken in the evening for best results because the enzyme that destroys cholesterol works best in the evening and the medication enhances this process. 3. Cholesterol-reducing medications can cause serious liver problems, and if a client has muscle pain, it is an adverse effect that should be reported to the HCP. 4. The cholesterol level is checked every few months, not on a daily basis.

The nurse is caring for a client receiving heparin sodium via constant infusion. The heparin protocol reads to increase the IV rate by 100 units/hour if the PTT is less than 50 seconds. The current PTT level is 46 seconds. The heparin comes in 500 mL of D5W with 25,000 units of heparin added. The current rate on the IV pump is 18 mL per hour. At what rate should the nurse set the pump?_______________

Answer: 20 mL per hour To determine the rate, the test taker must first determine how many units are in each mL of fluid; 25,000 divided by 500 50 units of heparin in each mL of fluid, and 50 divided into 100 2, and 2 18 20.

Which assessment data would cause the nurse to suspect the client has atherosclerosis? 1. Change in bowel movements. 2. Complaints of a headache. 3. Intermittent claudication. 4. Venous stasis ulcers.

Answer: 3 1. A change in bowel movements may indicate cancer but not atherosclerosis. 2. A headache is not a sign/symptom of atherosclerosis. 3. Intermittent claudication is a sign of generalized atherosclerosis and is a marker of atherosclerosis. 4. Atherosclerosis indicates arterial involve- ment, not venous involvement.

Which client would be most likely to develop an abdominal aortic aneurysm? 1. A 45-year-old female with a history of osteoporosis. 2. An 80-year-old female with congestive heart failure. 3. A 69-year-old male with peripheral vascular disease. 4. A 30-year-old male with a genetic predisposition to AAA.

Answer: 3 1. AAAs affect men four (4) times more often than women. 2. AAAs affect men four (4) times more often than women. 3. The most common cause of AAA is atherosclerosis (which is the cause of peripheral vascular disease); it occurs in men four (4) times more often than women and primarily in Caucasians. 4. AAAs occur most often in elderly men, and there is no genetic predisposition.

Which medication should the nurse expect the health-care provider to order for a client diagnosed with arterial occlusive disease? 1. An anticoagulant medication. 2. An antihypertensive medication. 3. An antiplatelet medication. 4. A muscle relaxant.

Answer: 3 1. An anticoagulant medication is prescribed for venous problems, such as deep vein thrombosis. 2. Arterial occlusive disease is caused by atherosclerosis, which may cause hypertension as well, but antihypertensive medications are not prescribed for arterial occlusive disease. 3. Antiplatelet medications, such as aspirin or clopidogrel (Plavix), inhibit platelet aggregations in the arterial blood. 4. A muscle relaxant will not help the leg pain since the origin of the pain is decreased oxygen to the muscle.

The client is being admitted with Coumadin (warfarin), an anticoagulant, toxicity. Which laboratory data should the nurse monitor? 1. Blood urea nitrogen levels (BUN). 2. Bilirubin levels. 3. International Normalized Ratio (INR). 4. Partial thromboplastin time (PTT).

Answer: 3 1. BUN lab tests are measurements of renal functioning. 2. Bilirubin is a liver function test. 3. PT/INR is a test to monitor warfarin (Coumadin) action in the body. 4. PTT levels monitor heparin activity.

The health-care provider prescribes an ACE inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for adminis- tering this medication? 1. ACE inhibitors prevent beta receptor stimulation in the heart. 2. This medication blocks the alpha receptors in the vascular smooth muscle. 3. ACE inhibitors prevent vasoconstriction and sodium and water retention. 4. ACE inhibitors decrease blood pressure by relaxing vascular smooth muscle.

Answer: 3 1. Beta-adrenergic blocking agents, not ACE in- hibitors, prevent the beta receptor stimulation in the heart, which decreases heart rate and cardiac output. 2. Alpha-adrenergic blockers, not ACE in- hibitors, block alpha receptors in the vascular smooth muscle, which decreases vasomotor tone and vasoconstriction. 3. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II, and this, in turn, prevents vasoconstriction and sodium and water retention. 4. Vasodilators, not ACE inhibitors, reduce blood pressure by relaxing vascular smooth muscle, especially in the arterioles.

Which instruction should the nurse include when providing discharge instructions to a client diagnosed with peripheral arterial disease? 1. Encourage the client to use a heating pad on the lower extremities. 2. Demonstrate to the client the correct way to apply elastic support hose. 3. Instruct the client to walk daily for at least 30 minutes. 4. Tell the client to check both feet for red areas at least once a week.

Answer: 3 1. External heating devices are avoided to reduce the risk of burns. 2. Elastic support hose reduce the circulation to the skin and are avoided. 3. Walking promotes the development of collateral circulation to ischemic tissue and slows the process of atherosclerosis. 4. The feet must be checked daily, not weekly.

The nurse knows the client understands the teaching concerning a low-fat, low- cholesterol diet when the client selects which meal? 1. Fried fish, garlic mashed potatoes, and iced tea. 2. Ham and cheese on white bread and whole milk. 3. Baked chicken, baked potato, and skim milk. 4. A hamburger, French fries, and carbonated beverage.

Answer: 3 1. Fried foods are high in fat and cholesterol. 2. White bread is not high in fiber; wheat bread should be recommended because it is high in fiber. Whole milk is high in fat; skim milk should be used. 3. Baked, broiled, or grilled meats are recommended; a plain baked potato is appropriate; and skim milk is low in fat—so this meal is appropriate for a low-fat, low-cholesterol diet. 4. Hamburger meat is high in fat, French fries are usually cooked in oil (which is high in fat), and carbonated beverages are high in calories.

The nurse is teaching a class on atherosclerosis. Which statement describes the scientific rationale as to why diabetes is a risk factor for developing atherosclerosis? 1. Glucose combines with carbon monoxide, instead of with oxygen, and this leads to oxygen deprivation of tissues. 2. Diabetes stimulates the sympathetic nervous system, resulting in peripheral constriction that increases the development of atherosclerosis. 3. Diabetes speeds the atherosclerotic process by thickening the basement membrane of both large and small vessels. 4. The increased glucose combines with the hemoglobin, which causes deposits of plaque in the lining of the vessels.

Answer: 3 1. Glucose does not combine with carbon monoxide. 2. Vasoconstriction is not a risk factor for developing atherosclerosis. 3. This is the scientific rationale for why diabetes mellitus is a modifiable risk factor for atherosclerosis. 4. When glucose combines with the hemo- globin in a laboratory test called glycosy- lated hemoglobin, the result can determine the client's average glucose level over the past three (3) months.

The client receiving low molecular weight heparin (LMWH) subcutaneously to prevent DVT following hip replacement surgery complains to the nurse that there are small purple hemorrhaged areas on the upper abdomen. Which action should the nurse implement? 1. Notify the HCP immediately. 2. Check the client's PTT level. 3. Explain that this results from the medication. 4. Assess the client's vital signs

Answer: 3 1. This occurs from the administration of the low molecular weight heparin and is not a reason to notify the HCP. 2. A therapeutic range will not be achieved with LMWH, and PTT levels are usually not done. 3. This is not hemorrhaging, and the client should be reassured that this is a side effect of the medication. 4. Assessing the vital signs will not provide any pertinent information to help answer the client's question.

The client diagnosed with essential hypertension asks the nurse, "Why do I have high blood pressure?" Which response by the nurse would be most appropriate? 1. "You probably have some type of kidney disease that causes the high BP." 2. "More than likely you have had a diet high in salt, fat, and cholesterol." 3. "There is no specific cause for hypertension, but there are many known risk factors." 4. "You are concerned that you have high blood pressure. Let's sit down and talk."

Answer: 3 1. Kidney disease leads to secondary hyperten- sion; secondary hypertension is elevated blood pressure resulting from an identifi- able underlying process. 2. A high-salt, high-fat, high-cholesterol diet is a risk factor for essential hypertension, but it is not the only cause; therefore, this would be an incorrect answer. 3. There is no known cause for essential hypertension, but many factors—both modifiable (obesity, smoking, diet) and nonmodifiable (family history, age, gender)—are risk factors for essential hypertension. 4. This is a therapeutic reply that is inappro- priate because the client needs facts.

The nurse is discharging a client diagnosed with DVT from the hospital. Which discharge instructions should be provided to the client? 1. Have the PTT levels checked weekly until therapeutic range is achieved. 2. Staying at home is best, but if traveling, airplanes are better than automobiles. 3. Avoid green leafy vegetables and notify the HCP of red or brown urine. 4. Wear knee stockings with an elastic band around the top.

Answer: 3 1. The client will be taking an oral anticoagulant, warfarin (Coumadin). Prothrombin time (PT) and International Normalized ratio (INR) levels, not partial thromboplastin time (PTT), are monitored when this medication is taken. The client should be in therapeutic range before discharge. The HCP will determine how often to monitor the levels, usually in two (2) to three (3) weeks and then at three (3) to six (6) month intervals. 2. The client is not restricted to the home. The client should not take part in any activity that does not allow frequent active and passive leg exercises. In an airplane the client should be instructed to drink plenty of fluids, move the legs up and down, and flex the muscles. If in an automobile, the client should take frequent breaks to walk around. 3. Green leafy vegetables contain vitamin K, which is the antidote for warfarin. These foods will interfere with the action of warfarin. Red or brown urine may indicate bleeding. 4. The client should be instructed to wear stockings that do not constrict any area of the leg.

The nurse has just received the A.M. shift report. Which client would the nurse assess first? 1. The client with a venous stasis ulcer who is complaining of pain. 2. The client with varicose veins who has dull aching muscle cramps. 3. The client with arterial occlusive disease who cannot move the foot. 4. The client with deep vein thrombosis who has a positive Homans' sign.

Answer: 3 1. The client with a venous stasis ulcer should have pain, so this would be expected. 2. Dull, aching muscle cramps are expected with varicose veins. 3. The inability to move the foot means that a severe neurovascular compromise has occurred, and the nurse should assess this client first. 4. A positive Homans' sign is expected in a client diagnosed with deep vein thrombosis.

The home health nurse is admitting a client diagnosed with a DVT. Which action by the client warrants immediate intervention by the nurse? 1. The client takes a stool softener every day at dinnertime. 2. The client is wearing a medic alert bracelet. 3. The client takes vitamin E over-the-counter medications. 4. The client has purchased a new recliner that will elevate the legs.

Answer: 3 1. There is nothing that contraindicates the use of a stool softener, and use of one may be recommended if the client is prone to constipation and hard stool that could cause some bleeding from hemorrhoids. 2. A medic alert bracelet notifies any emergency HCP of the client's condition and medications. 3. Vitamin E can affect the action of warfarin. The nurse should explain to the client that these and other medications could potentiate the action of warfarin. 4. This would be recommended for the client if the footrest does not restrict blood flow in the calves.

Which assessment data would warrant immediate intervention in the client diagnosed with arterial occlusive disease? 1. The client has 2+ pedal pulses. 2. The client is able to move the toes. 3. The client has numbness and tingling. 4. The client's feet are red when standing.

Answer: 3 1. These are normal pedal pulses and would not require any intervention. 2. Moving the toes is a good sign in a client with arterial occlusive disease. 3. Numbness and tingling are paresthesia, which is a sign of a severely decreased blood supply to the lower extremities. 4. Reddened extremities are expected secondary to increased blood supply when the legs are in the dependent position.

The nurse is teaching a class on venous insufficiency. The nurse would identify which condition as the most serious complication of chronic venous insufficiency? 1. Arterial thrombosis. 2. Deep vein thrombosis. 3. Venous ulcerations. 4. Varicose veins.

Answer: 3 1. Venous insufficiency is a venous problem, not an arterial problem. 2. Deep vein thrombosis is not a complication of chronic venous insufficiency, but it may be a cause. 3. Venous ulcerations are the most serious complication of chronic venous insufficiency. It is very difficult for these ulcerations to heal, and often clients must be seen in wound care clinics for treatment. 4. Varicose veins may lead to chronic venous insufficiency, but they are not a complication.

The nurse and an unlicensed assistive personnel (UAP) are caring for a 64-year-old client who is four (4) hours postoperative bilateral femoral-popliteal bypass surgery. Which nursing task should be delegated to the UAP? 1. Monitor the continuous passive motion machine. 2. Assist the client to the bedside commode. 3. Feed the client the evening meal. 4. Elevate the foot of the client's bed.

Answer: 4 1. A continuous passive motion machine is used for a client with a total knee replace- ment, not for this type of surgery. 2. The client will be on bedrest at four (4) hours after the surgery. Remember, the client had bilateral surgery on the legs. 3. There is nothing in the stem that would indicate the client could not feed himself or herself. The nurse should encourage independence as much as possible. 4. After the surgery, the client's legs will be elevated to help decrease edema. The surgery has corrected the decreased blood supply to the lower legs.

The client is employed in a job that requires extensive standing. Which intervention should the nurse include when discussing how to prevent varicose veins? 1. Wear low-heeled, comfortable shoes. 2. Wear white, clean, cotton socks. 3. Move the legs back and forth often. 4. Wear graduated compression hose.

Answer: 4 1. Low-heeled comfortable shoes should be recommended to help decrease foot pain, but they will not help prevent varicose veins. 2. Wearing white, clean socks will help prevent irritation to the feet. 3. Moving the legs back and forth often may help prevent deep vein thrombosis, but it will not prevent varicose veins. 4. Graduated compression hose help decrease edema and increase the circulation back to the heart; this helps prevent varicose veins.

The male client is diagnosed with Guillain Barré syndrome (GB) and is in the intensive care unit on a ventilator. Which cardiovascular rationale explains implementing passive range of motion (ROM) exercises? 1. Passive ROM will prevent contractures from developing. 2. The client will feel better if he is able to exercise and stretch his muscles. 3. Range of motion exercises will help alleviate the pain associated with GB. 4. They help to prevent DVTs by movement of the blood through the veins.

Answer: 4 1. Passive range of motion exercises are recommended to prevent contracture formation and muscle atrophy, but this is a musculoskeletal complication, not a cardiovascular one. 2. If the client is on a ventilator, then the paralysis associated with GB has moved up the spinal column to include the muscles of respiration. Passive range of motion exercises are done by the staff; the client will not be able to do active ROM. 3. Range of motion exercises will not alleviate the pain of GB. 4. One reason for performing range of motion exercises is to assist the blood vessels in the return of blood to the heart, preventing DVT.

The client asks the nurse, "My doctor just told me that atherosclerosis is why my legs hurt when I walk. What does that mean?" Which response by the nurse would be the best response? 1. "The muscle fibers and endothelial lining of your arteries have become thickened." 2. "The next time you see your HCP, ask what atherosclerosis means." 3. "The valves in the veins of your legs are incompetent so your legs hurt." 4. "You have a hardening of your arteries that decreases the oxygen to your legs."

Answer: 4 1. The nurse should assume the client is a layperson and should not explain disease processes using medical terminology. 2. This is passing the buck; the nurse should have the knowledge to answer this question. 3. Atherosclerosis involves the arteries, not the veins. 4. This response explains in plain terms why the client's legs hurt from athero- sclerosis.

The male client diagnosed with essential hypertension has been prescribed an alpha- adrenergic blocker. Which intervention should the nurse discuss with the client? 1. Eat at least one (1) banana a day to help increase the potassium level. 2. Explain that impotence is an expected side effect of the medication. 3. Take the medication on an empty stomach to increase absorption. 4. Change position slowly when going from lying to sitting position.

Answer: 4 1. The potassium level is not affected by an alpha-adrenergic blocker. 2. Impotence is a major cause of noncompliance with taking prescribed medications for hypertension in male clients. The noncom- pliance should be reported to the HCP immediately so the medication can be changed. 3. The medication can be taken on an empty or a full stomach, depending on whether the client becomes nauseated after taking the medication. 4. Orthostatic hypotension may occur when the blood pressure is decreasing and may lead to dizziness and light- headedness, so the client should change position slowly.

The client diagnosed with arterial occlusive disease is one (1) day postoperative right femoral-popliteal bypass. Which intervention should the nurse implement? 1. Keep the right leg in the dependent position. 2. Apply sequential compression devices to lower extremities. 3. Monitor the client's pedal pulses every shift. 4. Assess the client's leg dressing every four (4) hours.

Answer: 4 1. The right leg should be elevated to decrease edema, not flat or hanging off the side of the bed (dependent). 2. The left leg could have a sequential compression device to prevent deep vein thrombosis, but it should not be on the leg with an operative incision site. 3. The client is one (1) day postoperative, and the pedal pulses must be assessed more than once every eight (8) or 12 hours. 4. The leg dressing needs to be assessed for hemorrhaging or signs of infection.

The health-care provider ordered a femoral angiogram for the client diagnosed with arterial occlusive disease. Which intervention should the nurse implement? 1. Explain that this procedure will be done at the bedside. 2. Discuss with the client that he or she will be on bedrest with bathroom privileges. 3. Inform the client that no intravenous access will be needed. 4. Inform the client that fluids will be increased after the procedure.

Answer: 4 1. This procedure will be done in a catheterization laboratory or special room, not at the bedside, because machines are used to visualize the extent of the arterial occlusion. 2. The client will have to keep the leg straight for at least six (6) hours after the procedure to prevent bleeding from the femoral artery. 3. An intravenous contrast medium is injected and vessels are visualized using fluoroscopy and x-rays. 4. Fluids will help flush the contrast dye out of the body and help prevent kidney damage.

Which assessment data would the nurse expect to find in the client diagnosed with chronic venous insufficiency? 1. Decreased pedal pulses. 2. Cool skin temperature. 3. Intermittent claudication. 4. Brown discolored skin.

Answer: 4 68. 1. Pedal pulses are normal in venous insufficiency, but pulses are decreased or absent in arterial insufficiency. 2. The skin is warm in venous insufficiency; the skin is cool in arterial insufficiency. 3. Intermittent claudication, pain that occurs when walking, is a symptom of arterial insufficiency. 4. Chronic venous insufficiency leads to chronic edema that, in turn, causes a brownish pigmentation to the skin

The client diagnosed with peripheral vascular disease is overweight, has smoked two (2) packs of cigarettes a day for 20 years, and sits behind a desk all day. What is the strongest factor in the development of atherosclerotic lesions? 1. Being overweight. 2. Sedentary lifestyle. 3. High-fat, high-cholesterol diet. 4. Smoking cigarettes.

Answer: 4 1. Being overweight is not a risk factor for atherosclerotic lesions, but it does indicate that the client does not eat a healthy diet or exercise as needed. 2. Lack of exercise is a risk factor, but it is not the strongest. 3. Although the stem did not explicitly identify diet, the nurse should assume that a client who is obese would not eat a low-fat, low-cholesterol diet. 4. Tobacco use is the strongest factor in the development of atherosclerotic lesions. Nicotine decreases blood flow to the extremities and increases heart rate and blood pressure. It also increases the risk of clot formation by increasing the aggregation of platelets.

The client diagnosed with a DVT is placed on a medical unit. Which nursing interventions should be implemented? Select all that apply. 1. Place sequential compression devices on both legs. 2. Instruct the client to stay in bed and not ambulate. 3. Encourage fluids and a diet high in roughage. 4. Monitor IV site every shift and PRN. 5. Assess Homans' sign every 24 hours.

Answers: 2, 3, 4 1. Sequential compression devices provide gentle compression of the legs to prevent DVT, but they are not used to treat DVT because the compressions could cause the clot to break loose. 2. Clients should be on bed rest for five (5) to seven (7) days after diagnosis to allow time for the clot to adhere to the vein wall, thereby preventing embolization. 3. Bed rest and limited activity predispose the client to constipation. Fluids and diets high in fiber will help prevent constipation. Fluids will also help provide adequate fluid volume in the vasculature. 4. The client will be administered a heparin IV drip, which should be monitored. 5. Homans' sign is done to determine if a DVT is present. This client has already been diagnosed with a DVT. Manipulating the leg to determine Homans' sign could dislodge the clot.

What are characteristic of arteriospastic disease (Raynaud's phenomenon) (select all that apply)? a. Predominant in young females b. May be associated with autoimmune disorders c. Precipitated by exposure to cold, caffeine, and tobacco d. Involves small cutaneous arteries of the fingers and toes e. Inflammation of small and medium-sized arteries and veins f. Episodes involve white, blue, and red color changes of fingertips

a, b, c, d, f. Raynaud's phenomenon is predominant in young females and may be associated with autoimmune disorders (e.g., rheumatoid arthritis, scleroderma, systemic lupus erythematosus). Incidents occur with cold, emotional upsets, and caffeine or tobacco use due to vasoconstrictive effects. Small cutaneous arteries are involved and cause color changes of the fingertips or toes. When conservative management is ineffective, it may be treated with nifedipine (Procardia).

A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical changes may contribute to this patient's hypertension (select all that apply)? a. Decreased renal function b. Increased baroreceptor reflexes c. Increased peripheral vascular resistance d. Increased adrenergic receptor sensitivity e. Increased collagen and stiffness of the myocardium f. Loss of elasticity in large arteries from arteriosclerosis

a, c, e, f. The age-related changes that contribute to hypertension include decreased renal function, increased peripheral vascular resistance, increased collagen and stiffness of the myocardium, and decreased elasticity in large arteries from arteriosclerosis. The baroreceptor reflexes are blunted. The adrenergic receptor sensitivity and renin response are both decreased with aging.

A patient with PAD has a nursing diagnosis of ineffective peripheral tissue perfusion. What should be included in the teaching plan for this patient (select all that apply)? a. Keep legs and feet warm. b. Apply cold compresses when the legs become swollen. c. Walk at least 30 minutes per day to the point of discomfort. d. Use nicotine replacement therapy as a substitute for smoking. e. Inspect lower extremities for pulses, temperature, and any injury.

a, c, e. Warm legs and feet increase circulation. The lower extremities should be assessed at regular intervals for changes. Walking exercise increases oxygen extraction in the legs and improves skeletal muscle metabolism. The patient with PAD should walk at least 30 minutes a day, preferably twice a day. Exercise should be stopped when pain occurs and resumed when the pain subsides. Nicotine in all forms causes vasoconstriction and must be eliminated.

What should the nurse emphasize when teaching a patient who is newly prescribed clonidine (Catapres)? a. The drug should never be stopped abruptly. b. The drug should be taken early in the day to prevent nocturia. c. The first dose should be taken when the patient is in bed for the night. d. Because aspirin will decrease the drug's effectiveness, Tylenol should be used instead.

a. Centrally acting α-adrenergic blockers may cause severe rebound hypertension if the drugs are abruptly discontinued and patients should be taught about this effect because many are not consistently compliant with drug therapy. Diuretics should be taken early in the day to prevent nocturia and the profound orthostatic hypotension that occurs with first-dose α-adrenergic blockers can be prevented by taking the initial dose at bedtime. Aspirin use may decrease the effectiveness of ACE inhibitors.

What are characteristics of arterial disease (select all that apply)? a. Pruritus b. Thickened, brittle nails c. Dull ache in calf or thigh d. Decreased peripheral pulses e. Pallor on elevation of the legs f. Ulcers over bony prominences on toes and feet

b, d, e, f. Arterial disease is manifested in thick, brittle nails; decreased peripheral pulses; pallor when the legs are elevated; and ulcers over bony prominences on the toes and feet, as well as paresthesia.

During preoperative preparation of the patient scheduled for an AAA, why should the nurse establish baseline data for the patient? a. All physiologic processes will be altered postoperatively. b. The cause of the aneurysm is a systemic vascular disease. c. Surgery will be canceled if any physiologic function is not normal. d. BP and HR will be maintained well below baseline levels during the postoperative period.

b. Because atherosclerosis is a systemic disease, the patient with an A A A is likely to have cardiac, pulmonary, cerebral, or lower extremity vascular problems that should be noted and monitored throughout the perioperative period. Postoperatively, the BP is balanced: high enough to keep adequate flow through the artery to prevent thrombosis but low enough to prevent bleeding at the surgical site. b. The BP and peripheral pulses are evaluated every hour in the acute postoperative period to ensure that BP is adequate and that extremities are being perfused. BP is kept within normal range. If BP is too low, thrombosis of the graft may occur; if it is too high, it may cause leaking or rupture at the suture line. Hypothermia is induced during surgery but the patient is rewarmed as soon as surgery is completed. Fluid replacement to maintain urine output at 100 mL/hr would increase the BP too much and only 30 mL/hr of urine is needed to show adequate renal perfusion.

A patient with a small AAA is not a good surgical candidate. What should the nurse teach the patient is one of the best ways to prevent expansion of the lesion? a. Avoid strenuous physical exertion. b. Control hypertension with prescribed therapy. c. Comply with prescribed anticoagulant therapy. d. Maintain a low-calcium diet to prevent calcification of the vessel.

b. Increased systolic blood pressure (SBP) continually puts pressure on the diseased area of the artery, promoting its expansion. Small aneurysms can be treated by decreasing blood pressure (BP), modifying atherosclerosis risk factors, and monitoring the size of the aneurysm. Anticoagulants are used during surgical treatment of aneurysms but physical activity is not known to increase their size. Calcium intake is not related to calcification in arteries.

When teaching the patient with PAD about modifying risk factors associated with the condition, what should the nurse emphasize? a. Amputation is the ultimate outcome if the patient does not alter lifestyle behaviors. b. Modifications will reduce the risk of other atherosclerotic conditions such as stroke. c. Risk-reducing behaviors initiated after angioplasty can stop the progression of the disease. d. Maintenance of normal body weight is the most important factor in controlling arterial disease.

b. PAD occurs as a result of atherosclerosis and the risk factors are the same as for other diseases associated with atherosclerosis, such as CAD, cerebrovascular disease, and aneurysms. Major risk factors are tobacco use, hyperlipidemia, elevated C-reactive protein, diabetes mellitus, and uncontrolled hypertension. The risk for amputation is high in patients with severe occlusive disease but this is not the best approach to encourage patients to make lifestyle modifications.

A patient with stage 2 hypertension who is taking hydrochlorothiazide (HydroDiuril) and lisinopril (Prinivil) has prazosin (Minipress) added to the medication regimen. What is most important for the nurse to teach the patient to do? a. Weigh every morning to monitor for fluid retention b. Change position slowly and avoid prolonged standing c. Use sugarless gum or candy to help relieve dry mouth d. Take the pulse daily to note any slowing of the heart rate

b. Prazosin is an α-adrenergic blocker that causes dilation of arterioles and veins and causes orthostatic hypotension. The patient may feel dizzy, weak, and faint when assuming an upright position after sitting or lying down and should be taught to change positions slowly, avoid standing for long periods, do leg exercises to increase venous return, and lie or sit down when dizziness occurs. Direct-acting vasodilators often cause fluid retention; dry mouth occurs with diuretic use, although orthostatic hypotension may occur with hydrochlorothiazide as well; and centrally acting α- and β-blockers may cause bradycardia.

During the patient's acute postoperative period following repair of an AAA, the nurse should ensure that which goal is achieved? a. Hypothermia is maintained to decrease oxygen need. b. BP and all peripheral pulses are evaluated at least every hour. c. IV fluids are administered at a rate to maintain urine output of 100 mL/hr. d. The patient's BP is kept lower than baseline to prevent leaking at the incision line.

b. The BP and peripheral pulses are evaluated every hour in the acute postoperative period to ensure that BP is adequate and that extremities are being perfused. BP is kept within normal range. If BP is too low, thrombosis of the graft may occur; if it is too high, it may cause leaking or rupture at the suture line. Hypothermia is induced during surgery but the patient is rewarmed as soon as surgery is completed. Fluid replacement to maintain urine output at 100 mL/hr would increase the BP too much and only 30 mL/hr of urine is needed to show adequate renal perfusion.

A patient who is postoperative following repair of an AAA has been receiving IV fluids at 125 mL/hr continuously for the last 12 hours. Urine output for the last 4 hours has been 60 mL, 42 mL, 28 mL, and 20 mL, respectively. What is the priority action that the nurse should take? a. Monitor for a couple more hours. b. Contact the physician and report the decrease in urine output. c. Send blood for electrolytes, blood urea nitrogen (BUN), and creatinine. d. Decrease the rate of infusion to prevent blood leakage at the suture line.

b. The decreasing urine output is evidence that either the patient needs volume or there is reduced renal blood flow. The physician will want to be notified as soon as possible of this change in condition and may order laboratory tests. The other options are incorrect.

The patient who is being admitted has had a history of uncontrolled hypertension. High SVR is most likely to cause damage to which organ? a. Brain b. Heart c. Retina d. Kidney

b. The increased systemic vascular resistance (SVR) of hypertension directly increases the workload of the heart and heart failure occurs when the heart can no longer pump effectively against the increased resistance. The heart may be indirectly damaged by atherosclerotic changes in the blood vessels, as are the brain, retina, and kidney.

The nursing student is seeking assistance in hearing the patient's abnormal heart sounds. What should the nurse tell the student to do for a more effective assessment? a. Use the diaphragm of the stethoscope with the patient prone b. Use the diaphragm of the stethoscope with the patient supine c. Use the bell of the stethoscope with the patient leaning forward d. Use the bell of the stethoscope with the patient on the right side

c.

A surgical repair is planned for a patient who has a 5.5-cm abdominal aortic aneurysm (AAA). On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and dysphagia b. Severe back pain with flank ecchymosis c. Presence of a bruit in the periumbilical area d. Weakness in the lower extremities progressing to paraplegia

c. Although most abdominal aortic aneurysms (AAAs) are asymptomatic, on physical examination a pulsatile mass in the periumbilical area slightly to the left of the midline may be detected and bruits may be audible with a stethoscope placed over the aneurysm. Hoarseness and dysphagia may occur with aneurysms of the ascending aorta and the aortic arch. Severe back pain with flank ecchymosis is usually present on rupture of an AAA and neurovascular loss in the lower extremities may occur from pressure of a thoracic aneurysm.

Which classification of drugs used to treat hypertension prevents the action of angiotensin II and promotes increased salt and water excretion? a. Thiazide diuretics c. Angiotensin II receptor blockers (ARBs) b. Direct vasodilators d. Angiotensin-converting enzyme (ACE) inhibitors

c. Angiotensin II receptor blockers (ARBs) prevent the action of angiotensin II and produce vasodilation and increased salt and water excretion. Thiazide diuretics decrease extracellular fluid volume by increasing Na+ and Cl- excretion with water. Direct vasodilators act directly on smooth muscle of arterioles to cause vasodilation. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II.

What is the primary BP effect of β-adrenergic blockers such as atenolol (Tenormin)? a. Vasodilation of arterioles by blocking movement of calcium into cells b. Decrease Na+ and water reabsorption by blocking the effect of aldosterone c. Decrease CO by decreasing rate and strength of the heart and renin secretion by the kidneys d. Vasodilation caused by inhibiting sympathetic outflow from the central nervous system (CNS)

c. Cardioselective β-adrenergic blockers decrease CO, reduce sympathetic vasoconstrictor tone, and decrease renin secretion by kidneys. Calcium channel blockers reduce BP by causing blocking movement of calcium into cells, which causes vasodilation of arterioles. Spironolactone blocks the effect of aldosterone. Central adrenergic antagonists such as clonidine (Catapres) inhibit sympathetic outflow from the central nervous system (CNS).

Which manifestation is an indication that a patient is having a hypertensive emergency? a. Symptoms of a stroke with an elevated BP b. A systolic BP >200 mm Hg and a diastolic BP >120 mm Hg c. A sudden rise in BP accompanied by neurologic impairment d. A severe elevation of BP that occurs over several days or weeks

c. Hypertensive emergency, a type of hypertensive crisis, is a situation that develops over hours or days in which a patient's BP is severely elevated with evidence of acute target organ disease (e.g., cerebrovascular, cardiovascular, renal, or retinal). The neurologic manifestations are often similar to the presentation of a stroke but do not show the focal or lateralizing symptoms of stroke. Hypertensive crises are defined by the degree of organ damage and how rapidly the BP rises, not by specific BP measurements. A hypertensive urgency is a less severe crisis in which a patient's BP becomes severely elevated over days or weeks but there is no evidence of target organ damage.

During care of the patient following femoral bypass graft surgery, the nurse immediately notifies the health care provider if the patient experiences a. fever and redness at the incision site. b. 2+ edema of the extremity and pain at the incision site. c. a loss of palpable pulses and numbness and tingling of the feet. d. increasing ankle-brachial indices and serous drainage from the incision.

c. Loss of palpable pulses, numbness and tingling of the extremity, extremity pallor, cyanosis or cold, and decreasing ankle-brachial indices are indications of occlusion of the bypass graft and need immediate medical attention. Pain, redness, and serous drainage at the incision site are expected postoperatively.

Following teaching about medications for PAD, the nurse determines that additional instruction is necessary when the patient makes which statement? a. "I should take one aspirin a day to prevent clotting in my legs." b. "The lisinopril I use for my blood pressure may help me walk further without pain." c. "I will need to have frequent blood tests to evaluate the effect of the Coumadin I will be taking." d. "Pletal should help me increase my walking distance and help prevent clots from forming in my legs."

c. Oral anticoagulants (warfarin) are not recommended for treatment of PAD but all of the other statements are correct in relation to treatment of PAD.

A 38-year-old man is treated for hypertension with triamterene and hydrochlorothiazide (Maxzide) and metoprolol (Lopressor). Four months after his last clinic visit, his BP returns to pretreatment levels and he admits he has not been taking his medication regularly. What is the nurse's best response to this patient? a. "Try always to take your medication when you carry out another daily routine so you do not forget to take it." b. "You probably would not need to take medications for hypertension if you would exercise more and stop smoking." c. "The drugs you are taking cause sexual dysfunction in many patients. Are you experiencing any problems in this area? d. "You need to remember that hypertension can be only controlled with medication, not cured, and you must always take your medication."

c. Sexual dysfunction, which can occur with many of the antihypertensive drugs, including thiazide and potassium- sparing diuretics and β-adrenergic blockers, can be a major reason that a male patient does not adhere to his treatment regimen. It is helpful for the nurse to raise the subject because sexual problems may be easier for the patient to discuss and handle once it has been explained that the drug might be the source of the problem.

During the nursing assessment of the patient with a distal descending aortic dissection, what should the nurse expect the patient to manifest? a. Altered LOC with dizziness and weak carotid pulses b. A cardiac murmur characteristic of aortic valve insufficiency c. Severe "ripping" back or abdominal pain with decreasing urine output d. Severe hypertension and orthopnea and dyspnea of pulmonary edema

c. The onset of an aortic dissection involving the distal descending aorta is usually characterized by a sudden, severe, tearing pain in the back; as it progresses down the aorta, the kidneys, abdominal organs, and lower extremities may begin to show evidence of ischemia. Aortic dissections of the ascending aorta and aortic arch may affect the heart and circulation to the head, with the development of cerebral ischemia, murmurs, ventricular failure, and pulmonary edema.

A thoracic aortic aneurysm is found when a patient has a routine chest x-ray. The nurse anticipates that additional diagnostic testing to determine the size and structure of the aneurysm will include which test? a. Angiography b. Ultrasonography c. Echocardiography d. Computed tomography (CT) scan

d. A computed tomography (CT) scan is the most accurate test to determine the diameter of the aneurysm and whether a thrombus is present. The other tests may also be used but the CT scan yields the most descriptive results.

Which observation made by the nurse should indicate the presence of the complication of graft thrombosis after aortic aneurysm repair? a. Cardiac dysrhythmias or chest pain b. Absent bowel sounds, abdominal distention, or diarrhea c. Increased temperature and increased white blood cell count d. Decreased pulses and cool, painful extremities below the level of repair

d. Decreased or absent pulses in conjunction with cool, painful extremities below the level of repair indicate graft thrombosis. Cardiac dysrhythmias or chest pain indicates myocardial ischemia. Absent bowel sounds, abdominal distention, diarrhea, or bloody stools indicate bowel infarction. Increased temperature and white blood cells, surgical site inflammation, or drainage indicates graft infection.

Dietary teaching that includes dietary sources of potassium is indicated for the hypertensive patient taking which drug? a. Enalapril (Vasotec) c. Spironolactone (Aldactone) b. Labetalol (Normodyne) d. Hydrochlorothiazide (HydroDiuril)

d. Hydrochlorothiazide is a thiazide diuretic that causes sodium and potassium loss through the kidneys. High- potassium foods should be included in the diet or potassium supplements should be used to prevent hypokalemia. Enalapril and spironolactone may cause hyperkalemia by inhibiting the action of aldosterone and potassium supplements should not be used by patients taking these drugs. As a combined α/β-blocker, labetalol does not affect potassium levels.

Which drugs are most commonly used to treat hypertensive crises? a. Esmolol (Brevibloc) and captopril (Capoten) b. Enalaprilat (Vasotec) and minoxidil (Loniten) c. Labetalol (Normodyne) and bumetanide (Bumex) d. Fenoldopam (Corlopam) and sodium nitroprusside (Nipride)

d. Hypertensive crises are treated with IV administration of antihypertensive drugs, including the vasodilators sodium nitroprusside, fenoldopam, and nicardipine; adrenergic blockers such as phentolamine, labetalol, and esmolol; the ACE inhibitor IV enalaprilat; and the calcium channel blocker clevidipine. Sodium nitroprusside is the most effective parenteral drug for hypertensive emergencies. Drugs that are used specifically for hypertensive emergencies include sodium nitroprusside, nitroglycerin with myocardial infarction, hydralazine with other medications, and oral captopril.

When obtaining a health history from a 72-year-old man with peripheral arterial disease (PAD) of the lower extremities, the nurse asks about a history of related conditions, including a. venous thrombosis. b. venous stasis ulcers. c. pulmonary embolism. d. coronary artery disease (CAD).

d. Regardless of the location, atherosclerosis is responsible for peripheral arterial disease (PAD) and is related to other cardiovascular disease and its risk factors, such as coronary artery disease (CAD) and carotid artery disease. Venous thrombosis, venous stasis ulcers, and pulmonary embolism are diseases of the veins and are not related to atherosclerosis.

Which aneurysm is uniform in shape and a circumferential dilation of the artery? a. False aneurysm b. Pseudoaneurysm c. Saccular aneurysm d. Fusiform aneurysm

d. The fusiform aneurysm is circumferential and relatively uniform in shape. The false aneurysm or pseudoaneurysm is not an aneurysm but a disruption of all of the arterial wall layers with bleeding that is contained by surrounding anatomic structures. Saccular aneurysms are the pouchlike bulge of an artery.