Chapter 18: PrepU - Nursing Management: Patients With Vascular Disorders and Problems of Peripheral Circulation

A nurse and physician are preparing to visit a hospitalized client with perepheral arterial disease. As you approach the client's room, the physician asks if the client has reported any intermittent claudication. The client has reported this symptom. The nurse explains to the physician which of the following details? 1- The client can walk about 50 feet before getting pain in the right lower leg. 2- The client's fingers tingle when left in one position for too long. 3- The client experiences shortness of breath after walking about 50 feet. 4- The client's legs awaken him during the night with itching.

1

A nurse is caring for a client following an arterial vascular bypass graft in the leg. What should the nurse plan to assess over the next 24 hours? 1- Peripheral pulses every 15 minutes after surgery 2- Ankle-arm indices every 12 hours 3- Blood pressure every 2 hours 4- Color of the leg every 4 hours

1

A patient who had a colon resection 3 days ago is complaining of discomfort in the left calf. How should the nurse assess Homan's sign to determine if the patient may have a thrombus formation in the leg? 1- Dorsiflex the foot while the leg is elevated to check for calf pain. 2- Elevate the patient's legs for 20 minutes and then lower them slowly while checking for areas of inadequate blood return. 3- Extend the leg, plantar flex the foot, and check for the patency of the dorsalis pedis pulse. 4- Lower the patient's legs and massage the calf muscles to note any areas of tenderness.

1

A patient with a diagnosis of deep vein thrombosis (DVT) is being treated with unfractionated heparin, which is being administered intravenously. The nurse who is providing care for this patient should consequently prioritize what assessments? 1- Assessing the patient for internal or external hemorrhage 2- Monitoring the patient's intake and output, and assessing for signs of fluid volume deficit 3- Assessing the patient for adventitious lung sounds and assessing SaO2 levels 4- Assessing the patient's pain levels

1

On a routine visit to the physician, a client with chronic arterial occlusive disease reports that he's stopped smoking after 34 years. To relieve symptoms of intermittent claudication, a condition associated with chronic arterial occlusive disease, which additional measure should the nurse recommend? 1- Taking daily walks 2- Engaging in anaerobic exercise 3- Reducing daily fat intake to less than 45% of total calories 4- Abstaining from foods that increase levels of high-density lipoproteins (HDLs)

1

The most common site of aneurysm formation is in the: 1- abdominal aorta, just below the renal arteries. 2- ascending aorta, around the aortic arch. 3- descending aorta, beyond the subclavian arteries. 4- aortic arch, around the ascending and descending aorta.

1

The nurse assesses a patient with hip pain related to intermittent claudication. She knows that the area of arterial narrowing is the: 1- Common iliac artery. 2- Common femoral artery. 3- Anterior tibial. 4- Posterior tibial.

1

The nurse assessing a client who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which characteristic? 1- Diminished or absent pulses 2- Superficial ulcer 3- Aching, cramping pain 4- Pulses that are present but difficult to palpate

1

The nurse is admitting a 32-year-old woman who is to undergo major surgery and will be on bed rest for at least 48 hours. While doing the admission assessment, the patient tells the nurse that she takes oral contraceptives. The nurse should recognize that this puts the patient at an increased risk of developing what health problem? 1- Deep vein thrombosis (DVT) 2- Intermittent claudication 3- Raynaud's disease 4- Thoracic aneurysm

1

The nurse is caring for a patient who returned from the tropics 2 weeks ago. The patient has been diagnosed with lymphangitis and is experiencing lymphedema. You are aware that the lymphedema may be due to what? 1- Obstructed lymph vessels 2- Sensitivity to antibiotics 3- Excessive lymph is the vascular space 4- Improper anticoagulant use

1

The nurse is monitoring a patient who is on heparin anticoagulant therapy. What should the nurse determine the therapeutic range of the international normalized ratio (INR) should be? 1- 2.0-3.0 2- 4.0-5.0 3- 5.0-6.0 4- 7.0-8.0

1

The nurse is preparing a teaching plan for a patient with venous insufficiency and plans to address measures to prevent complications from venous insufficiency. What is one measure the nurse should include in the plan? 1- Avoiding tight-fitting socks 2- Reducing activity 3- Sleeping with legs dependent 4- Avoiding pressure stockings

1

What should the nurse do to manage persistent swelling in a client with severe lymphangitis and lymphadenitis? 1- Teach the client how to apply a graduated compression stocking. 2- Inform the physician if the client's temperature remains low. 3- Avoid elevating the area. 4- Offer cold applications to promote comfort and to enhance circulation.

1

When administering heparin anticoagulant therapy, the nurse needs to make certain that the activated partial thromboplastin time (aPTT) is within the therapeutic range of: 1- 1.5 to 2.5 times the baseline control. 2- 2.5 to 3.0 times the baseline control. 3- 3.5 times the baseline control. 4- 4.5 times the baseline control.

1

Which aneurysm occurs as a result of infection at arterial suture or graft sites? 1- Anastomotic 2- False 3- Dissecting 4- Saccular

1

Which class of medication lyses and dissolves thrombi? 1- Fibrinolytic 2- Anticoagulant 3- Platelet inhibitors 4- Factor XA inhibitors

1

Which is a characteristic of arterial insufficiency? 1- Diminished or absent pulses 2- Superficial ulcer 3- Aching, cramping pain 4- Pulses are present but may be difficult to palpate

1

Which observation regarding ulcer formation on the client's lower extremity indicates that the ulcer is a result of venous insufficiency? 1- Border of the ulcer is irregular 2- Though superficial, it is very painful 3- Base is pale to black 4- Is deep, involving the joint space

1

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? 1- Intermittent claudication 2- Acute limb ischemia 3- Dizziness 4- Vertigo

1

Which of the following is the most common site for a dissecting aneurysm? 1- Thoracic area 2- Lumbar area 3- Sacral area 4- Cervical area

1

The nurse is assessing a patient with suspected acute venous insufficiency. What clinical manifestations would indicate this condition to the nurse? (Select all that apply.) 1- Cool and cyanotic skin 2- Initial absence of edema 3- Sharp pain that may be relieved by the elevation of the extremity 4- Full superficial veins 5- Brisk capillary refill of the toes

1,3,4

A client with a diagnosed abdominal aortic aneurysm (AAA) develops severe lower back pain. Which is the most likely cause? 1- The aneurysm has become obstructed. 2- The aneurysm may be preparing to rupture. 3- The client is experiencing inflammation of the aneurysm. 4- The client is experiencing normal sensations associated with this condition.

2

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? 1- Peripheral vascular disease 2- Raynaud's disease 3- Arterial occlusive diseases 4- Buerger's disease

2

A community health nurse is providing an educational event at the local seniors' center. The topic the nurse is speaking about is varicose veins. What would the nurse suggest as proactive preventative measure for varicose veins? 1- Sitting with crossed legs to promote relaxation 2- Walking for several minutes every hour to promote circulation 3- Elevating the legs when tired 4- Wearing tight ankle socks to decrease edema

2

A female client is readmitted to the facility with a warm, tender, reddened area on her right calf. Which contributing factor should the nurse recognize as most important? 1- History of increased aspirin use 2- Recent pelvic surgery 3- An active daily walking program 4- A history of diabetes mellitus

2

A patient is having an angiography to detect the presence of an aneurysm. After the contrast is administered by the interventionist, the patient begins to complain of nausea and difficulty breathing. What medication is a priority to administer at this time? 1- Metoprolol (Lopressor) 2- Epinephrine 3- Hydrocortisone (Solu-Cortef) 4- Cimetidine (Tagamet)

2

A pregnant client who developed deep vein thrombosis (DVT) in her right leg is receiving heparin I.V. on the medical floor. Physical therapy is ordered to maintain her mobility and prevent additional DVT. A nursing assistant working on the medical unit helps the client with bathing, range-of-motion exercises, and personal care. Which collaborative multidisciplinary considerations should the care plan address? 1- The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include sequential compression device application and strict bed rest. 2- The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising. 3- The client is at risk for developing another DVT; therefore, the care plan should include reporting redness, tenderness, or edema in the other lower extremity. 4- The client is pregnant and receiving I.V. heparin, placing her at risk for premature labor; therefore, the care plan should include reporting signs of premature labor.

2

As the clinic nurse caring for a client with varicose veins, what is an appropriate nursing action for this client? 1- Demonstrate how to self-administer IV infusions. 2- Demonstrate how to apply and remove elastic support stockings. 3- Assess for the sites of bleeding. 4- Assess for skin integrity.

2

The nurse has written a plan of care for a 54-year-old man diagnosed with peripheral arterial insufficiency. One of the nursing diagnoses in the care plan is altered peripheral tissue perfusion related to compromised circulation. What is the most appropriate intervention for this diagnosis? 1- Elevate his legs and arms above his heart when resting. 2- Encourage the patient to engage in a moderate amount of exercise. 3- Encourage long periods of sitting or standing. 4- Discourage walking to decrease pain.

2

The nurse is taking a health history on a new patient. The patient reports experiencing pain in the left lower leg and foot when walking, but claims that the pain is relieved with rest. The nurse notes that the patient's left lower leg is slightly edematous and hairless. What should the nurse suspect that the patient may be experiencing? 1- Coronary artery disease (CAD) 2- Intermittent claudication 3- Arterial embolus 4- Raynaud's disease

2

The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is 1- air plethysmography. 2- contrast phlebography. 3- lymphangiography. 4- lymphoscintigraphy.

2

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? 1- Loose and wrinkled skin 2- Ulcers and infection in the edematous area 3- Evident scarring 4- Cyanosis

2

Which of the following assessment results is considered a major risk factor for PAD? 1- LDL of 100 mg/dL 2- BP of 160/110 mm Hg 3- Cholesterol of 200 mg/dL 4- Triglyceride level of 150 mg/dL

2

A client in the emergency department states, "I have always taken a morning walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." Based on this statement, which priority assessment should the nurse complete? 1- Check for the presence of tortuous veins bilaterally on the legs. 2- Ask about any changes in skin color that occur in response to cold. 3- Attempt to palpate the dorsalis pedis and posterior tibial pulses. 4- Assess for unilateral swelling and tenderness of either leg.

3

A client is receiving enoxaparin and warfarin therapy for a venous thromboembolism (VTE). Which laboratory value indicates that anticoagulation is adequate and enoxaparin can be discontinued? 1- Activated partial thromboplastin time (aPPT) is half of the control value 2- Prothrombin time (PT) is 0.5 times normal. 3- International normalized ratio (INR) is 2.5. 4- K+ level is 3.5.

3

A patient with diabetes is being treated for a wound on the lower extremity that has been present for 30 days. What option for treatment is available to increase diffusion of oxygen to the hypoxic wound? 1- Surgical debridement 2- Enzymatic debridement 3- Hyperbaric oxygen 4- Vacuum-assisted closure device

3

A physician admits a client to the health care facility for treatment of an abdominal aortic aneurysm. When planning this client's care, which goal should the nurse keep in mind as she formulates interventions? 1- Decreasing blood pressure and increasing mobility 2- Increasing blood pressure and reducing mobility 3- Stabilizing heart rate and blood pressure and easing anxiety 4- Increasing blood pressure and monitoring fluid intake and output

3

A woman has sought care from her nurse practitioner for the treatment of a wound on her lower leg that has been slow to heal. When planning this patient's care, what action should the nurse first perform? 1- Cleanse the wound bed with normal saline and apply a hydrocolloid dressing. 2- Take a culture and sensitivity swab from the wound bed. 3- Determine whether the ulcer results from arterial insufficiency or venous insufficiency. 4- Prescribe the woman a course of broad-spectrum antibiotics.

3

The nurse is admitting a 45-year-old man to the medical-surgical unit. The patient has a diagnosis of Buerger's disease. While the nurse is taking the patient's health history, he reveals that he smokes about 2 packs of cigarettes a day, has a history of alcohol abuse, and does not exercise. What would be the priority teaching for this patient? 1- The lack of exercise, which is the identified cause of Buerger's disease 2- The likelihood that not exercising may cause his death in the near future without a significant change in behavior 3- That cigarettes contain nicotine, which is a powerful vasoconstrictor and may cause or aggravate Buerger's disease 4- The fact that alcohol suppresses the immune system, creates high glucose levels, and may cause Buerger's disease

3

The nurse is assisting a patient with peripheral arterial disease to ambulate in the hallway. What should the nurse include in the education of the patient during ambulation? 1- "As soon as you feel pain, we will go back and elevate your legs." 2- "If you feel pain during the walk, keep walking until the end of the hallway is reached." 3- "Walk to the point of pain, rest until the pain subsides, then resume ambulation." 4- "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

3

When being assessed by her new nurse practitioner, a woman states that she has had Raynaud's disease for many years, a problem that occasionally affects her quality of life. When performing health education surrounding this problem, what should the nurse emphasize? 1- Teaching the woman about atherosclerosis and its role in Raynaud's disease 2- Teaching the woman about the correct use of anticoagulants 3- Helping the woman identify and avoid the specific triggers of her problem 4- Teaching the woman the signs and symptoms of deep vein thrombosis

3

When caring for a patient with leg ulcers, the positioning of the legs depends on whether the patient's ulcer is arterial or venous in origin. How should the nurse position a patient who has leg ulcers that are venous in origin? 1- Keep the patient's legs flat without the knees raised. 2- Keep the patient's knees at a 45-degree angle. 3- Elevate the patient's lower extremities. 4- Hang the patient's legs over the side of the bed

3

A 56-year-old woman with severe varicose veins has opted for venous ablation, and the nurse is providing patient education before the scheduled procedure. What instructions should the nurse provide to this patient? 1- "Try to limit your activity for the first 10 days to 2 weeks to prevent reoccurrence of your varicose veins." 2- "You might experience some pain after the procedure, but this will be managed with ice packs rather than medications." 3- "If you notice any bruising in the area, make sure to let someone know because that could be a sign of a serious complication." 4- "We'll help you get walking as soon as you sedation has worn off, and you'll continue to gradually increase your activity level."

4

A client is diagnosed with deep vein thrombosis (DVT). Which nursing diagnosis should receive highest priority at this time? 1- Impaired gas exchange related to increased blood flow 2- Excess fluid volume related to peripheral vascular disease 3- Risk for injury related to edema 4- Ineffective peripheral tissue perfusion related to venous congestion

4

A nurse is instructing a client about using antiembolism stockings. Antiembolism stockings help prevent deep vein thrombosis (DVT) by: 1- encouraging ambulation to prevent pooling of blood. 2- providing warmth to the extremity. 3- elevating the extremity to prevent pooling of blood. 4- forcing blood into the deep venous system.

4

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? 1- "I like to soak my feet in the hot tub every day." 2- "I walk only to the mailbox in my bare feet." 3- "I stopped smoking and use only chewing tobacco." 4- "I have my wife look at the soles of my feet each day."

4

The nurse is caring for a patient who has started anticoagulant therapy with warfarin (Coumadin). When does the nurse understand that therapeutic benefits will begin? 1- Within 12 hours 2- Within the first 24 hours 3- In 2 days 4- In 3 to 5 days

4

To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the: 1- Inside of the ankle just above the heel. 2- Exterior surface of the foot near the heel. 3- Outside of the foot just below the heel. 4- Anterior surface of the foot near the ankle joint.

4

Two days after undergoing a total abdominal hysterectomy, a client complains of left calf pain. Venography reveals deep vein thrombosis (DVT). When assessing this client, the nurse is likely to detect: 1- pallor and coolness of the left foot. 2- a decrease in the left pedal pulse. 3- loss of hair on the lower portion of the left leg. 4- left calf circumference 1" (2.5 cm) larger than the right.

4

Which of the following medications is considered a thrombolytic? 1- Alteplase 2- Heparin 3- Coumadin 4- Lovenox

1

Which sign or symptom suggests that a client's abdominal aortic aneurysm is extending? 1- Increased abdominal and back pain 2- Decreased pulse rate and blood pressure 3- Retrosternal back pain radiating to the left arm 4- Elevated blood pressure and rapid respirations

1

Which of the following are alterations noted in Virchow's triad? Select all that apply. 1- Stasis of blood 2- Vessel wall injury 3- Altered coagulation 4- Edema 5- Tenderness

1,2,3

Which of the following is accurate regarding the effects of nicotine and tobacco smoke on the body? Select all that apply. 1- Causes vasospasm 2- Reduces circulation to the extremities 3- Impairs transport and cellular use of oxygen 4- Increases blood viscosity 5- Decreases blood viscosity

1,2,3,4

When assessing a client with cellulitis of the right leg, which finding should the nurse expect to observe? 1- Painful skin that is swollen and pale in color 2- Cold, red skin 3- Small, localized blackened area of skin 4- Red, swollen skin with inflammation spreading to surrounding tissues

4

A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions is appropriate for the nurse to give the client for promoting circulation to the extremities? 1- Keep the extremities elevated slightly. 2- Participate in a regular walking program. 3- Use a heating pad to promote warmth. 4- Massage the calf muscles if pain occurs.

2

A 61-year-old man has a longstanding history of peripheral artery disease that has progressed in recent months to acute limb ischemia (ALI). As a result, he has just undergone bilateral arterial bypass grafts and is postoperative day 1. The nurse's most recent assessment reveals that the patient's left foot is cold to touch and dusky in appearance with nonpalpable peripheral pulses. How should the nurse respond to this assessment finding? 1- Report the finding to the surgeon immediately. 2- Encourage the patient to perform light activity and assist with range of motion exercises. 3- Place a warm compress on the patient's foot to stimulate circulation. 4- Administer a dose of the patient's prescribed anticoagulant.

1

A client is hospitalized for repair of an abdominal aortic aneurysm. The nurse must be alert for signs and symptoms of aneurysm rupture and thus looks for which of the following? 1- Constant, intense back pain and falling blood pressure 2- Constant, intense headache and falling blood pressure 3- Higher than normal blood pressure and falling hematocrit 4- Slow heart rate and high blood pressure

1

A community health nurse teaches a group of older adults about modifiable risk factors that contribute to the development of peripheral arterial disease (PAD). The nurse knows that the teaching was effective based on which statement? 1- "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." 2- "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." 3- "The older I get the higher my risk for peripheral arterial disease gets." 4- "Because my family is from Italy, I have a higher risk of developing peripheral arterial disease."

1

A home health nurse is seeing an elderly female client for the first time. During the physical assessment of the client's feet, the nurse notes several circular ulcers around the tips of the toes on both feet. The bases of the ulcers are pale, and the client reports the ulcers to be very painful. From these assessment findings, the nurse suspects that the cause of the ulcers is which of the following? 1- Arterial insufficiency 2- Venous insufficiency 3- Neither venous nor arterial 4- Trauma

1

A client admitted to the medical-surgical unit with a venous thromboembolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are needed. Which response by the nurse is accurate? 1- "Administration of two anticoagulants decreases the risk of recurrent venous thrombosis." 2- "Enoxaparin will dissolve the clot, and warfarin will prevent any more clots from occurring." 3- "The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect." 4- "Because of the potential for a pulmonary embolism, it is important for you to take at least two anticoagulants."

3

Which is a risk factor for venous disorders of the lower extremities? 1- Trauma 2- Pacing wires 3- Obesity 4- Surgery

3