Ch 38 Vascular Disorders

A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of these statements by the patient is most consistent with the diagnosis?

A. "I can't get my shoes on at the end of the day." Because the edema associated with venous insufficiency increases when the patient has beenstanding, shoes will feel tighter at the end of the day.

The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says,

A. "I should reduce the amount of green, leafy vegetables that I eat." Patients taking Coumadin are taught to follow a consistent diet w/regard to foods that are high in vitamin K, such as green, leafy vegetables.

A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient?

A. Cessation of smoking Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease.

A patient with a history of an abdominal aortic aneurysm is admitted to the emergency department (ED) with severe back pain and absent pedal pulses. Which action should the nurse take first?

A. Obtain the blood pressure. Patient is experiencing aortic dissection, the nurse's first action should be to determine the hemodynamic status by assessing blood pressure.

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which medication category will the nurse plan to include when providing patient teaching about PAD management?

A. Statins current research indicates that statin use by patients with PAD improves multiple outcomes.

When caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty, which action should the nurse take first?

A. Take the blood pressure and pulse rate, take vital signs Bleeding is a possible complication after catheterization of the femoral artery, nurse's first action should be to assess for changes in vital signs that might indicate hemorrhage.

A patient at the clinic says, "I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." The nurse should

A. attempt to palpate the dorsalis pedis and posterior tibial pulses. : The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication.

The health care provider prescribes an infusion of argatroban (Acova) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to

A. avoid giving any IM medications to prevent localized bleeding. IM injections are avoided in patients receiving anticoagulation.

33. Which actions could the nurse delegate to unlicensed assistive personnel (UAP) who are providing care for a patient who is at risk for venous thromboembolism?

Apply sequential compression device whenever the patient is in bed. UAP training includes the use of equipment that requires minimal nursing judgment, such as sequential compression devices.

A patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, it will be most important to ask about

B. difficulty swallowing. Difficulty swallowing may occur with a thoracic aneurysm because of pressure on the esophagus.

31. The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider?

Blood pressure 137/88 mm Hg The blood pressure is typically kept at less than 120 mm Hg systolic to minimize extension of the dissection.

In evaluating the patient outcomes following teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says,

B. "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet." Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns.

When developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD), which information should the nurse include?

B. "It is very important that you stop smoking cigarettes." Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death.

Which of these patients admitted to the emergency department should the nurse assess first?

B. 50-year-old who is complaining of "tearing" chest pain, & sudden "sharp" &worst ever" upper back pain The patient's presentation is consistent with dissecting thoracic aneurysm, which will require rapid intervention.

When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important to communicate to the health care provider?

B. Loose, bloody stools Loose, bloody stools may indicate intestinal ischemia or infarction & should be reported immediately, the patient may need an emergency bowel resection

Which nursing action will be included in the plan of care after endovascular repair of an abdominal aortic aneurysm?

B. Monitor fluid intake and urine output. Because renal artery occlusion can occur after endovascular repair, the nurse should monitorparameters of renal function such as intake and output.

Which information about a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse?

B. New onset shortness of breath New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as oxygen administration and notification of the health care provider. The other findings are typical of VTE.)

A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene?

B. The LPN/LVN has the patient sit in a bedside chair for 90 minutes. Patient should avoid sitting long periods, increased stress on the suture line caused by leg edema & because of the risk for venous thromboembolism (VTE).

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective?

B. The patient exercises indoors during the winter months. Patients should avoid temperature extremes by exercising indoors when it is cold.

A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that

B. compression stockings should be applied before getting out of bed. Compression stockings are applied with the legs elevated to reduce pressure in the lower legs.

Which topic will the nurse include in patient teaching for a patient with a venous stasis ulcer on the right lower leg?

C. Application of compression to the leg Compression of the leg is essential to healing of venous stasis ulcers.

A patient tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynaud's phenomenon. The nurse will anticipate teaching the patient about tests for

C. autoimmune disorders. Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis, & patients should be screened for autoimmune disorders.

The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe would expect to find

C. prolonged capillary refill in all the toes. Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery.

32. A patient is being evaluated for post-thrombotic syndrome. Which assessment will the nurse perform?

Check for presence of lipodermatosclerosis. Clinical signs of post-thrombotic syndrome include lipodermatosclerosis.

The nurse reviews the admission orders shown in the accompanying figure for a patient newly diagnosed with peripheral artery disease. Which admission order should the nurse question?

Combined clopidogrel and omeprazole therapy Because the antiplatelet effect of clopidogrel is reduced when it is used with omeprazole, the nurse should clarify this prescription with the health care provider.

While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information?

D. "My legs cramp whenever I walk more than a block." Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication.

Which nursing action in the care plan for a patient who had an open repair of an abdominal aortic aneurysm 3 days previously is appropriate for the nurse to delegate to experienced nursing assistive personnel (NAP)?

D. Help the patient to use a pillow to splint while coughing. Reshowing patient how to cough is part of routine postoperative care and w/in the education & scope of practice for an experienced NAP.

Which action by a nurse who is administering fondaparinux (Arixtra) to a patient with venous thromboembolism (VTE) indicates that more education about the medication is needed?

D. The nurse ejects the air bubble in the syringe before administering the Arixtra. The air bubble is not ejected before giving Arixtra.

When discussing risk factor modification for a 60-year-old patient who has a 4-cm abdominal aortic aneurysm, the nurse will focus patient teaching on which of these patient risk factors?

D. Uncontrolled hypertension Hypertension can potentially be modified to decrease the patient's risk for further expansion of the aneurysm

Several hours after an open surgical repair of an abdominal aortic aneurysm, the patient develops a urinary output of 20 mL/hr for 2 hours. The nurse notifies the health care provider and anticipates orders for

D. a blood urea nitrogen (BUN) level. The pain and decreased urine output suggest a renal artery embolism, and monitoring of renal function is needed.

A patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. The nurse should notify the health care provider and

D. keep the patient in bed in the supine position. Patient's is consistent w/acute arterial occlusion, & resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored.

The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with deep vein thrombosis. The best method for the nurse to use in elevating the patient's feet is to

D. put one pillow under the thighs and two pillows under the lower legs. The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing two pillows under the feet and one under the thighs.

A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate?

Lovenox works immediately, Coumadin takes few days to effect coagulation." Low molecular weight heparin, is used for immediate effect on coagulation & discontinued once the international normalized ratio, INR, value indicates that the warfarin has reached a therapeutic level.

The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment, the patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first?

Notify the surgeon and anesthesiologist. Lower extremity pulses may be absent for a short time after surgery because of vasospasm and hypothermia.

34. The nurse who works in the vascular clinic has several patients with venous insufficiency scheduled today. Which patient should the nurse assign to an experienced LPN/LVN?

Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg LPN education and scope of practice includes wound care.

24. Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which action should the nurse take first?

Review the preoperative assessment form for data about the pulses. Patients w/aortic aneurysms have peripheral arterial disease, nurse will check preoperative assessment to find if pulses were present b4 surgery b4 notifying health care providers of absent pulses