Exam 5 Vascular Prep U Questions Chapter 30

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

Stasis of blood Vessel wall injury Altered coagulation

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) 1.5 to 2.5 times the baseline control. A normal PTT level is 21 to 35 seconds. A reading of more than 100 seconds indicates a significant risk of hemorrhage

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)Arterial insufficiency Characteristics of arterial insuffiency ulcers include location at the tips of the toes, extreme painfulness, and circular shape with pale to black ulcer bases. Ulcers caused by venous insufficiency will be irregular in shape, minimal pain if superficial (can be painful), and usually located around the ankles or the anterier tibial area.

Health teaching includes advising patients on ways to reduce PAD. The nurse should always emphasize that the strongest risk factor for the development of atherosclerotic lesions is: 1)Cigarette smoking. 2)Lack of exercise. 3)Obesity. 4)Stress.

1)Cigarette smoking. Nicotine decreases blood flow, increases heart rate and blood pressure, and increases the risk for clot formation by increasing platelet aggregation. Smokers have a four-fold higher risk of developing pain from arterial disease than nonsmokers. Carbon monoxide, produced by burning tobacco, combines with hemoglobin more readily than oxygen, thus depriving tissues of oxygen.

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)Diminished or absent pulses Occlusive arterial disease impairs blood flow and can reduce or obliterate palpable pulsations in the extremities. A diminished or absent pulse is a characteristic of arterial insufficiency.

Providing postoperative care to a patient who has percutaneous transluminal angioplasty (PTA), with insertion of a stent, for a femoral artery lesion, includes assessment for the most serious complication of: 1)Hemorrhage. 2)Thrombosis of the graft. 3)Decreased motor function. 4)Stent dislodgement.

1)Hemorrhage All choices are serious and require medical/surgical intervention. However, hemorrhage is the most serious complication that requires immediate attention.

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)Increased abdominal and back pain Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar nerve root and is causing more pain. The pulse rate would increase with aneurysm extension. Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would decrease with aneurysm extension, and the respiratory rate may not be affected.

A client is diagnosed with peripheral arterial disease. Review of the client's chart shows an ankle-brachial index (ABI) on the right of 0.45. This indicates that the right foot has which of the following? 1)Moderate to severe arterial insufficiency 2)No arterial insufficiency 3)Very mild arterial insufficiency 4)Tissue loss to that foot

1)Moderate to severe arterial insufficiency Normal people without arterial insufficiency have an ABI of about 1.0. Those with an ABI of 0.95 to 0.5 have mild to moderate arterial insufficiency. Those with an ABI of less than 0.50 have ischemic rest pain. Those with tissue loss have severe ischemia and an ABI of 0.25 or less.

A nurse should be prepared to manage complications following abdominal aortic aneurysm resection. Which complication is most common? 1)Renal failure 2)Hemorrhage and shock 3)Graft occlusion 4)Enteric fistula

1)Renal failure Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the kidneys. Hemorrhage and shock are the most common complications before abdominal aortic aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric fistula formation are rare complications of abdominal aortic aneurysm repair.

The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm? 1)Severe back pain 2)Hematemesis 3)Rectal bleeding 4)Hypertensive crisis

1)Severe back pain Pressure from an enlarging or dissecting abdominal aortic aneurysm is likely to be exhibited as severe back pain. A decrease in blood pressure will result as the client goes into shock from hemorrhaging. Blood in emesis or rectal bleeding is not associated with rupture of AAA.

A client is being discharged home with a venous stasis ulcer on the right lower leg. Which topic will the nurse include in client teaching before discharge? 1)Adequate carbohydrate intake 2)Application of graduated compression stockings 3)Prophylactic antibiotic therapy 4)Methods of keeping the wound area dry

2)Application of graduated compression stockings Graduated compression stockings usually are prescribed for clients with venous insufficiency. The required pressure gradient is determined by the amount and severity of venous disease. Graduated compression stockings are designed to apply 100% of the prescribed pressure gradient at the ankle and pressure that decreases as the stocking approaches the thigh, reducing the caliber of the superficial veins in the leg and increasing flow in the deep veins. These stockings may be knee high, thigh high, or pantyhose.

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless temporary change? 1)Purplish stools 2)Bluish urine 3)Redness of the upper part of the feet 4)Coldness of the soles

2)Bluish urine Lymphangiography may turn the urine blue temporarily; it doesn't alter stool color. For several months after the procedure, the upper part of the feet may appear blue, not red. Lymphangiography doesn't affect the soles.

The nurse is performing wound care for a patient with a necrotic sacral wound. The prescribed treatment is isotonic saline solution with fine mesh gauze and a dry dressing to cover. What type of debridement is the nurse performing? 1)Surgical debridement 2)Nonselective debridement 3)Enzymatic debridement 4)Selective debridement

2)Nonselective debridement Nonselective débridement can be accomplished by applying isotonic saline dressings of fine mesh gauze to the ulcer. When the dressing dries, it is removed (dry), along with the debris adhering to the gauze. Pain management is usually necessary.

A postoperative client is receiving heparin after developing thrombophlebitis. The nurse monitors the client carefully for bleeding and other adverse effects of heparin. If the client starts to exhibit signs of excessive bleeding, the nurse should expect to administer an antidote that is specific to heparin. Which agent fits this description? 1)Phytonadione (vitamin K) 2)Protamine sulfate 3)Thrombin 4)Plasma protein fraction

2)Protamine sulfate Protamine sulfate is the antidote specific to heparin. Phytonadione (vitamin K) is the antidote specific to oral anticoagulants such as warfarin. (Heparin isn't given orally.) Thrombin is a hemostatic agent used to control local bleeding. Plasma protein fraction, a blood derivative, supplies colloids to the blood and expands plasma volume; it's used to treat clients who are in shock.

A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses; paresthesia; and a mottled, cyanotic, cold, and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: 1) place a heating pad around the affected calf. 2) elevate the affected leg as high as possible. 3) keep the affected leg level or slightly dependent. 4) shave the affected leg in anticipation of surgery.

3) keep the affected leg level or slightly dependent. While the physician makes treatment decisions, the nurse should maintain the client on bed rest, keeping the affected leg level or slightly dependent (to aid circulation) and protecting it from pressure and other trauma. Warming the leg with a heating pad (or chilling it with an ice pack) would further compromise tissue perfusion and increase injury to the leg. Elevating the leg would worsen tissue ischemia. Shaving an ischemic leg could cause accidental trauma from cuts or nicks.

A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency? 1) Elevate the legs periodically for at least an hour. 2)Avoid foods with iodine. 3)Elevate the legs periodically for at least 15 to 20 minutes. 4)Refrain from sexual activity for a week.

3)Elevate the legs periodically for at least 15 to 20 minutes. The nurse should advise the client to periodically elevate the legs for at least 15 to 20 minutes. Avoiding foods with iodine or refraining from sexual activity for a week does not relate to venous insufficiency.

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)Hyperbaric oxygen Hyperbaric oxygenation (HBO) may be beneficial as an adjunct treatment in patients with diabetes with no signs of wound healing after 30 days of standard wound treatment. HBO is accomplished by placing the patient into a chamber that increases barometric pressure while the patient is breathing 100% oxygen.

A client with Raynaud's disease complains of cold and numbness in the fingers. Which of the following would the nurse identify as an early sign of vasoconstriction? 1)Cyanosis 2)Gangrene 3)Pallor 4)Clubbing of the fingers

3)Pallor Pallor is the initial symptom in Raynaud's followed by cyanosis and aching pain. Gangrene can occur with persistent attacks and interference of blood flow. Clubbing of the fingers is a symptom associated with chronic oxygen deprivation to the distal phalanges

A physician orders blood coagulation tests to evaluate a client's blood-clotting ability. The nurse knows that such tests are important in assessing clients at risk for thrombi, such as those with a history of atrial fibrillation, infective endocarditis, prosthetic heart valves, or myocardial infarction. Which test determines a client's response to oral anticoagulant drugs? 1)Bleeding time 2)Platelet count 3)Prothrombin time (PT) 4)Partial thromboplastin time (PTT)

3)Prothrombin time (PT) PT determines a client's response to oral anticoagulant therapy. This test measures the time required for a fibrin clot to form in a citrated plasma sample following addition of calcium ions and tissue thromboplastin and compares this time with the fibrin-clotting time in a control sample. The physician should adjust anticoagulant dosages as needed, to maintain PT at 1.5 to 2.5 times the control value. Bleeding time indicates how long it takes for a small puncture wound to stop bleeding. The platelet count reflects the number of circulating platelets in venous or arterial blood. PTT determines the effectiveness of heparin therapy and helps physicians evaluate bleeding tendencies. Physicians diagnose appoximately 99% of bleeding disorders on the basis of PT and PTT values.

A health care provider wants a cross-sectional image of the abdomen to evaluate the degree of stenosis in a patient's left common iliac artery. The nurse knows to prepare the patient for which of the following? 1)Doppler ultrasound 2)Magnetic resonance angiography (MRA) 3)Angiography 4)Computed tomography angiography (CTA)

4)Computed tomography angiography (CTA) A CTA is used to visualize arteries and veins and help assess for stenosis and occlusion.

Which statement is accurate regarding Reynaud disease? 1)The disease generally affects the client bilaterally. 2)It affects more than two digits on each hand or foot. 3) It is most common in men 16 to 40 years of age. 4)Episodes may be triggered by unusual sensitivity to cold.

4)Episodes may be triggered by unusual sensitivity to cold. Episodes of Reynaud disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between 16 and 40 years of age. It is generally unilateral and affects only one or two digits

The most important factor regulating the caliber of blood vessels, which determines resistance to flow, is: 1)Hormonal secretion. 2)Independent arterial wall activity. 3)The influence of circulating chemicals. 4)The sympathetic nervous system.

4)The sympathetic nervous system. Stimulation of the sympathetic nervous system causes vasoconstriction thus regulating blood flow. Norepinephrine is the responsible neurotransmitter.

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)forcing blood into the deep venous system. Antiembolism stockings prevent DVT by forcing blood into the deep venous system, instead of allowing blood to pool. Ambulation prevents blood from pooling and prevents DVT, but encouraging ambulation isn't a function of the stockings. Antiembolism stockings could possibly provide warmth, but this factor isn't how they prevent DVT. Elevating the extremity decreases edema but doesn't prevent DVT.

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)left calf circumference 1" (2.5 cm) larger than the right. Signs of DVT include inflammation and edema in the affected extremity, causing its circumference to exceed that of the opposite extremity. Pallor, coolness, decreased pulse, and hair loss in an extremity signal interrupted arterial blood flow, which doesn't occur in DVT.

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.

Attempt to palpate the dorsalis pedis and posterior tibial pulses Intermittent claudication is a sign of peripheral arterial insufficiency. The nurse should assess for other clinical manifestations of peripheral arterial disease in a client who describes intermittent claudication. A thorough assessment of the client's skin color and temperature and the character of the peripheral pulses are important in the diagnosis of arterial disorders.

To check for arterial insufficiency when a client is in a supine position, the nurse should elevate the extremity at a 45-degree angle and then have the client sit up. The nurse suspects arterial insufficiency if the assessment reveals: 1)elevational rubor. 2)no rubor for 10 seconds after the maneuver. 3)dependent pallor. 3)a 30-second filling time for the veins.

Dependent Pallor If arterial insufficiency is present, elevation of the limb would yield a pallor from the lack of circulation. Rubor and increased venous filling time would suggest venous problems secondary to venous trapping and incompetent valves.

Which aneurysm results in bleeding into the layers of the arterial wall? 1)Saccular 2)Dissecting 3)False 4)Anastomotic

Dissecting Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial layers of the arterial wall. Saccular aneurysms collect blood in the weakened outpouching. In a false aneurysm, the mass is actually a pulsating hematoma. An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites.

A client in the ED has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining the client's history, which symptoms will it be most important for the nurse to ask about? 1)Back or lumbar pain 2)Hoarse voice and difficulty swallowing 3)Abdominal swelling and tenderness 4)Changes in bowel and bladder habits

Hoarse voice and difficulty swallowing Symptoms are dyspnea, the result of pressure of the aneurysm sac against the trachea, a main bronchus, or the lung itself; cough, frequently paroxysmal and with a brassy quality; hoarseness, stridor, or weakness or complete loss of the voice (aphonia), resulting from pressure against the laryngeal nerve; and dysphagia (difficulty in swallowing) due to impingement of the aneurysm on the esophagus.

The nurse is caring for a client who is scheduled to have a vein ligation in the morning. How would you describe a vein ligation to the client? 1)Veins are tied off and removed. 2)Removal of the great saphenous vein. 3)Veins are tied off and left in the leg. 4)Removal of the small saphenous vein.

Veins are tied off and removed. A vein ligation is a procedure in which the affected veins are ligated (tied off) above and below the area of incompetent valves, but the dysfunctional vein remains. A vein stripping is the removal of the veins after being tied off