Med Surg Ch. 38
A 46-year-old is diagnosed with thromboangiitis obliterans (Buerger's disease). When the nurse is developing a discharge teaching plan for the patient, which outcome has the highest priority for this patient?
a. Cessation of all tobacco use
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?
a. Notify the surgeon and anesthesiologist.
An 80-year-old patient with a history of an abdominal aortic aneurysm arrives at the emergency department (ED) with severe back pain and absent pedal pulses. Which actions should the nurse take first?
a. Obtain the blood pressure.
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 most appropriate?
"Lovenox will work right away, but Coumadin takes several days to have an effect on preventing clots.
When assessing a patient with possible peripheral artery disease (PAD), the nurse obtains a brachial BP of 147/82 and an ankle pressure of 112/74. The nurse calculates the patient's ankle-brachial index (ABI) as ________ (round up to the nearest hundredth).
0.76 The ABI is calculated by dividing the ankle systolic BP by the brachial systolic BP.
A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency. Which patient statement is most supportive of the diagnosis?
a. "I can't get my shoes on at the end of the day."
A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of medications will the nurse plan to include when providing patient teaching about PAD management?
a. Statins
A patient who is 2 days post-femoral-popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN) caring for the patient requires the registered nurse (RN) to intervene?
a. The LPN/LVN has the patient sit in a chair for 90minutes.
After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which action by the patient demonstrates that the teaching has been effective?
a. The patient exercises indoors during the winter months.
The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says which of the following?
b "I should reduce the amount of green, leaft vegetables that I eat."
When developing a teaching plan for a 76-year-old patient newly diagnosed with peripheral artery disease (PAD), which instructions should the nurse include?
b. "It is very important that you stop smoking cigarettes."
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?
b. Apply sequential compression device whenever the patient is in bed.
A patient has a 6-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining an admission history from the patient, it will be most important for the nurse to ask about
b. trouble swallowing.
When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which assessment finding is most important for the nurse to communicate to the health care provider?
b. Loose, bloody stools
Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm?
b. Monitor fluid intake and urine output.
The nurse is 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 perform first?
b. Obtain vital signs.
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 licensed practical/vocational nurse (LPN/LVN)?
b. Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg
The health care provider prescribes an infusion of heparin (Hep-Lock) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to:
b. avoid giving any IM medications to prevent localized bleeding.
When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, "I will:
b. use a heating pad on my feet at night to increase the circulation and warmth in my feet."
After receiving report, which patient admitted to the emergency department should the nurse assess first?
c. 50-year-old who is complaining of sudden "sharp" and "worst ever" upper back pain
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?
c. Blood pressure 137/88 mm Hg
A 46-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Which instructions should the nurse provide to the patient before discharge?
c. Elastic compression stockings should be applied before getting out of bed.
Which assessment finding for a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse?
c. New onset shortness of breath
Which action by a nurse who is giving fondaparinux (Arixtra) to a patient with a lower leg venous thromboembolism (VTE) indicates that more education about the drug is needed?
c. The nurse ejects the air bubble in the syringe before giving the drug.
A 23-year-old patient tells the health care provider about experiencing cold, numb fingers when running during the winter and Raynaud's phenomenon is suspected. The nurse will anticipate teaching the patient about tests for:
c. 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 right second toe would expect to find
c. prolonged capillary refill in all the toes.
While working in the outpatient clinic, the nurse notes that a patient has a history of intermittent claudication. Which statement by the patient would support this information?
d. "My legs cramp whenever I walk more than a block."
Which topic should the nurse include in patient teaching for a patient with a venous stasis ulcer on the left lower leg?
d. Application of elastic compression stockings
A patient is being evaluated for post-thrombotic syndrome. Which assessment will the nurse perform?
d. Check for presence of 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?
d. Combined clopidogrel and omeprazole therapy
Which nursing intervention for a patient who had an open repair of an abdominal aortic aneurysm 2 days previously is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?
d. Help the patient to use a pillow to splint while coughing.
The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism. Which action by the nurse to elevate the patient's feet is best?
d. One pillow is placed under the thighs and two pillows are placed under the lower legs.
When discussing risk factor modification for a 63-year-old patient who has a 5-cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which patient risk factor?
d. Uncontrolled hypertension
A patient at the clinic says, "I have always taken a walk after dinner, but lately my leg cramps and hurts after just a few minutes of starting. The pain goes away after I stop walking, though." The nurse should:
d. assess for the presence of the dorsalis pedis and posterior tibial pulses.
Several hours after an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse that urinary output for the past 2 hours has been 40 mL. The nurse notifies the health care provider and anticipates an order for a(n)
d. blood urea nitrogen (BUN) level.
A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the health care provider and immediately
d. keep the patient in bed in the supine position.
