Peripheral Vascular Disease/Peripheral Arterial Disease Prep-U/Test-Bank

The clinic nurse is caring for a 57-year-old client who reports experiencing leg pain whenever walking several blocks. The client has type 1 diabetes and has smoked a pack of cigarettes every day for the past 40 years. The health care provider diagnoses intermittent claudication. The nurse should provide which instruction about long-term care to the client? A. "Be sure to practice meticulous foot care." B. "Consider cutting down on your smoking." C. "Reduce your activity level to accommodate your limitations." D. "Try to make sure you eat enough protein."

A. "Be sure to practice meticulous foot care." Rationale: The client with peripheral vascular disease or diabetes should receive education or reinforcement about skin and foot care. Intermittent claudication and other chronic peripheral vascular diseases reduce oxygenation to the feet, making them susceptible to injury and poor healing; therefore, meticulous foot care is essential. The client should stop smoking—not just cut down—because nicotine is a vasoconstrictor. Daily walking benefits the client with intermittent claudication. Increased protein intake will not alleviate the client's symptoms.

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? A. "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." B. "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels." C. "The older I get the higher my risk for peripheral arterial disease gets." D. "Because my family is from Italy, I have a higher risk of developing peripheral arterial disease."

A. "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." Rationale: The use of tobacco products may be one of the most important risk factors in the development of atherosclerotic lesions. Nicotine in tobacco decreases blood flow to the extremities and increases heart rate and blood pressure by stimulating the sympathetic nervous system. This causes vasoconstriction, thereby decreasing arterial blood flow. It also increases the risk of clot formation by increasing the aggregation of platelets.

A client reports pain and cramping in the thigh when climbing stairs and numbness in the legs after exertion. Which diagnostic test with the physician likely perform right in the office to determine PAD? A. ankle-brachial index B. exercise electrocardiography C. electron beam computed tomography D. photoplethysmography

A. ankle-brachial index Rationale: The client's symptoms indicate possible peripheral artery disease (PAD). The ankle-brachial index is a simple, noninvasive test used for this diagnosis. An exercise electrocardiography may be ordered for a client with possible CAD. An EBCT is a radiologic test that produces x-rays of the coronary arteries using an electron beam. It is used to diagnose for CAD. Clients with suspected venous insufficiency will undergo photoplethysmography, a diagnostic test that measures light that is not absorbed by hemoglobin and consequently is reflected back to the machine.

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

B. The aneurysm may be preparing to rupture. Rationale: Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized to the middle or lower abdomen to the left of the midline. Low-back pain may be present because of pressure of the aneurysm on the lumbar nerves. Indications of a rupturing AAA include constant, intense back pain; falling blood pressure; and decreasing hematocrit. Rupture into the peritoneal cavity is quickly fatal. A retroperitoneal rupture of an aneurysm may result in hematomas in the scrotum, perineum, flank, or penis.

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? A. Loose and wrinkled skin B. Ulcers and infection in the edematous area C. Evident scaring D. Cyanosis

B. Ulcers and infection in the edematous area Rationale: In a client with lymphedema, the tissue nutrition is impaired as a result of the stagnation of lymphatic fluid, leading to ulcers and infection in the edematous area. Later, the skin also appears thickened, rough, and discolored. Scaring does not occur in clients with lymphedema. Cyanosis is a bluish discoloration of the skin and mucous membranes.

The nurse is providing care for a client who has just been diagnosed with peripheral arterial occlusive disease (PAD). What assessment finding is most consistent with this diagnosis? A. Numbness and tingling in the distal extremities B. Unequal peripheral pulses between extremities C. Visible clubbing of the fingers and toes D. Reddened extremities with muscle atrophy

B. Unequal peripheral pulses between extremities Rationale: PAD assessment may manifest as unequal pulses between extremities, with the affected leg cooler and paler than the unaffected leg. Intermittent claudication is far more common than sensations of numbness and tingling. Clubbing and muscle atrophy are not associated with PAD.

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? A. "Administration of two anticoagulants decreases the risk of recurrent venous thrombosis." B. "Enoxaparin will dissolve the clot, and warfarin will prevent any more clots from occurring." C. "The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect." D. "Because of the potential for a pulmonary embolism, it is important for you to take at least two anticoagulants."

C. "The enoxaparin will work immediately, but the warfarin takes several days to achieve its full effect." Rationale: Oral anticoagulants such as warfarin are monitored by the prothrombin time (PT) or the international normalized ratio (INR). Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0).

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? A. "As soon as you feel pain, we will go back and elevate your legs." B. "If you feel pain during the walk, keep walking until the end of the hallway is reached." C. "Walk to the point of pain, rest until the pain subsides, then resume ambulation." D. "If you feel any discomfort, stop and we will use a wheelchair to take you back to your room."

C. "Walk to the point of pain, rest until the pain subsides, then resume ambulation." Rationale: The nurse instructs the patient to walk to the point of pain, rest until the pain subsides, and then resume walking so that endurance can be increased as collateral circulation develops. Pain can serve as a guide in determining the appropriate amount of exercise.

A nurse is admitting a client to the medical unit who has a history of peripheral artery disease (PAD). While providing the health history, the client reports smoking about two packs of cigarettes a day, having a history of alcohol abuse, and not exercising. Which topic would be the priority health education for this client? A. The lack of exercise, which is the main cause of PAD B. The likelihood that heavy alcohol intake is a significant risk factor for PAD C. The nicotine in cigarettes, which is a powerful vasoconstrictor and may cause or aggravate PAD D. Alcohol, which suppresses the immune system, creates high glucose levels, and may cause PAD

C. The nicotine in cigarettes, which is a powerful vasoconstrictor and may cause or aggravate PAD Rationale: Tobacco is powerful vasoconstrictor; its use with PAD is highly detrimental, and clients are strongly advised to stop using tobacco. Sedentary lifestyle is also a risk factor, but smoking is likely a more significant risk factor that the nurse should address. Alcohol use is less likely to cause PAD, although it carries numerous health risks.

A client presents to the clinic reporting the inability to grasp objects with the right hand. The client's right arm is cool and has a difference in blood pressure of more than 20 mm Hg compared with the left arm. The nurse should expect that the primary provider may diagnose the client with which health problem? A. Lymphedema B. Raynaud phenomenon C. Upper extremity arterial occlusive disease D. Upper extremity venous thromboembolism (VTE)

C. Upper extremity arterial occlusive disease Rationale: The client with upper extremity arterial occlusive disease typically complains of arm fatigue and pain with exercise (forearm claudication) and inability to hold or grasp objects (e.g., combing hair, placing objects on shelves above the head) and, occasionally, difficulty driving. Assessment findings include coolness and pallor of the affected extremity, decreased capillary refill, and a difference in arm blood pressures of more than 20 mm Hg. These symptoms are not closely associated with Raynaud disease or lymphedema. The upper extremities are rare sites for VTE.

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? A. Veins are tied off and removed. B. The great saphenous vein is removed. C. Veins are tied off and left in the leg. D. The small saphenous vein is removed.

C. Veins are tied off and left in the leg. Rationale: 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.

A nurse is teaching a client who will soon be discharged with a prescription for warfarin (Coumadin). Which statement should the nurse include in discharge teaching? A. "Eat more yogurt and broccoli." B. "This drug will dissolve any clots you may still have." C. "If you miss a dose, double the next dose." D. "Don't take aspirin while you're taking warfarin."

D. "Don't take aspirin while you're taking warfarin." Rationale: Because aspirin decreases platelet aggregation and interferes with clotting, concomitant use of aspirin with warfarin, an anticoagulant, may lead to excessive anticoagulant effects — and bleeding. Warfarin therapy is most effective with consistent dietary intake of vitamin K. Increase intake of foods rich in vitamin K, such as broccoli, could change the client's warfarin dose requirements. Although warfarin interrupts the normal clotting cycle, it doesn't dissolve clots that have already formed. The client should take warfarin exactly as ordered to maintain the desired level of anticoagulation. Doubling a dose could cause bleeding.

Approximately what percentage of the arterial lumen must be obstructed before intermittent claudication is experienced? A. 20 B. 30 C. 40 D. 50

D. 50 Rationale: Typically, about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced.

The nurse is caring for a patient with venous insufficiency. For what should the nurse assess the patient's lower extremities? A. Rubor B. Cellulitis C. Dermatitis D. Ulceration

D. Ulceration Rationale: Venous ulceration is the most serious complication of chronic venous insufficiency and can be associated with other conditions affecting the circulation of the lower extremities. Cellulitis or dermatitis may complicate the care of chronic venous insufficiency and venous ulcerations.

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: A. pallor and coolness of the left foot. B. a decrease in the left pedal pulse. C. loss of hair on the lower portion of the left leg. D. left calf circumference 1" (2.5 cm) larger than the right.

D. left calf circumference 1" (2.5 cm) larger than the right. Rationale: 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.

The nurse assesses a patient with hip pain related to intermittent claudication. She knows that the area of arterial narrowing is the: A. Common iliac artery. B. Common femoral artery. C. Anterior tibial. D. Posterior tibial.

A. Common iliac artery. Rationale: The location of the claudication occurs in muscle groups distal to the diseased vessel. Hip or buttock pain may result from reduced blood flow from the common iliac artery.

Which of the following are indications of a rupturing aortic aneurysm? Select all that apply. A. Constant, intense back pain B. Decreasing blood pressure C. Decreasing hematocrit D. Increasing blood pressure E. Increasing hematocrit

A. Constant, intense back pain B. Decreasing blood pressure C. Decreasing hematocrit Rationale: Indications of a rupturing abdominal aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

The nurse is caring for a client recovering from surgery to treat aortoiliac disease. Which assessment findings indicate to the nurse that manual manipulation of the bowel occurred during the surgery? Select all that apply. A. Abdominal distention B. Coffee-ground emesis C. Liquid bowel movement D. Left lower quadrant pain E. Absence of bowel sounds

A. Abdominal distention E. Absence of bowel sounds Rationale: The treatment of aortoiliac disease is essentially the same as that for atherosclerotic PAD. If there is significant aortic disease, the surgical procedure of choice is the aortoiliac graft. If possible, the distal graft is anastomosed to the iliac artery, and the entire surgical procedure is performed within the abdomen. Because of this, abdominal assessment for bowel sounds and paralytic ileus is to be done at least every 8 hours. Abdominal distention and the absence of bowel sounds indicate paralytic ileus. Coffee-ground emesis is an indication of gastrointestinal bleeding which is not associated with surgery to treat aortoiliac disease. A liquid bowel movement may indicate bowel ischemia which is caused by an occlusion of the mesenteric blood supply. Left lower quadrant abdominal pain is not associated with treatment of aortoiliac disease.

Which aneurysm occurs as a result of infection at arterial suture or graft sites? A. Anastomotic B. False C. Dissecting D. Saccular

A. Anastomotic Rationale: An anastomotic aneurysm occurs as a result of infection, arterial wall failure, and suture or graft failure. 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.

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? A. Arterial insufficiency B. Venous insufficiency C. Neither venous nor arterial D. Trauma

A. Arterial insufficiency Rationale: Characteristics of arterial insufficiency 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 anterior tibial area.

A client who has undergone a femoral to popliteal bypass graft surgery returns to the surgical unit. Which assessments should the nurse perform during the first postoperative day? A. Assess pulse of affected extremity every 15 minutes at first. B. Palpate the affected leg for pain during every assessment C. Assess the client for signs and symptoms of compartment syndrome every 2 hours. D. Perform Doppler evaluation once daily.

A. Assess pulse of affected extremity every 15 minutes at first. Rationale: The primary objective in the postoperative period is to maintain adequate circulation through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary refill, and sensory and motor function of the affected extremity are checked and compared with those of the other extremity; these values are recorded initially every 15 minutes and then at progressively longer intervals if the client's status remains stable. Doppler evaluations should be performed every 2 hours. Pain is regularly assessed, but palpation is not the preferred method of performing this assessment. Compartment syndrome results from the placement of a cast, not from vascular surgery.

A nurse is creating an education plan for a client with venous insufficiency. Which measure should the nurse include in the plan? A. Avoid normal stockings that are tight. B. Limit activities, including walking. C. Sleep with legs below heart level. D. Refrain from using graduated compression stockings.

A. Avoid normal stockings that are tight. Rationale: Measures taken to prevent complications include avoiding tight-fitting socks and panty girdles; maintaining activities, such as walking; sleeping with legs elevated; and using pressure stockings. Not included in the teaching plan for venous insufficiency would be reducing activity, sleeping with legs dependent, and avoiding pressure stockings. Each of these actions exacerbates venous insufficiency.

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: A. Cigarette smoking. B. Lack of exercise. C. Obesity. D. Stress.

A. Cigarette smoking. Rationale: 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.

Pentoxifylline (Trental) is a medication used for which of the following conditions? A. Claudication B. Thromboemboli C. Hypertension D. Elevated triglycerides

A. Claudication Rationale: Trental and Pletal are the only medications specifically indicated for the treatment of claudication. Thromboemboli, hypertension, and elevated triglycerides are not indications for using Trental.

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? A. Constant, intense back pain and falling blood pressure B. Constant, intense headache and falling blood pressure C. Higher than normal blood pressure and falling hematocrit D. Slow heart rate and high blood pressure

A. Constant, intense back pain and falling blood pressure Rationale: Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling blood pressure; and decreasing hematocrit.

Which of the following is a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot? A. Contrast phlebography B. Air plethysmography C. Lymphangiography D. Lymphoscintigraphy

A. Contrast phlebography Rationale: When a thrombus exists, an X-ray image will disclose an unfilled segment of a vein. Air plethysmography quantifies venous reflux and calf muscle pump ejection. In lymphangiography, contrast media are injected into the lymph system. In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.

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? A. Dorsiflex the foot while the leg is elevated to check for calf pain. B. Elevate the patient's legs for 20 minutes and then lower them slowly while checking for areas of inadequate blood return. C. Extend the leg, plantar flex the foot, and check for the patency of the dorsalis pedis pulse. D. Lower the patient's legs and massage the calf muscles to note any areas of tenderness.

A. Dorsiflex the foot while the leg is elevated to check for calf pain. Rationale: Homan's sign is indicated by pain in the calf after the foot is sharply dorsiflexed.

When assessing venous disease in a client's lower extremities, the nurse knows that what test will most likely be prescribed? A. Duplex ultrasonography B. Echocardiography C. Positron emission tomography (PET) D. Radiography

A. Duplex ultrasonography Rationale: Duplex ultrasound may be used to determine the level and extent of venous disease as well as its chronicity. Radiographs (x-rays), PET scanning, and echocardiography are never used for this purpose as they do not allow visualization of blood flow.

The nurse is admitting a 32-year-old woman to the presurgical unit. The nurse learns during the admission assessment that the client takes oral contraceptives. The nurse's postoperative plan of care should include what intervention? A. Early ambulation and leg exercises B. Cessation of the oral contraceptives until 3 weeks' postoperative C. Doppler ultrasound of peripheral circulation twice daily D. Dependent positioning of the client's extremities when at rest

A. Early ambulation and leg exercises Rationale: Oral contraceptive use increases blood coagulability; with bed rest, the client may be at increased risk of developing deep vein thrombosis. Leg exercises and early ambulation are among the interventions that address this risk. Assessment of peripheral circulation is important, but Doppler ultrasound may not be necessary to obtain these data. Dependent positioning increases the risk of venous thromboembolism (VTE). Contraceptives are not normally discontinued to address the risk of VTE in the short term.

The nurse is evaluating a client's diagnosis of arterial insufficiency with reference to the adequacy of the client's blood flow. On what physiologic variables does adequate blood flow depend? Select all that apply. A. Efficiency of heart as a pump B. Adequacy of circulating blood volume C. Ratio of platelets to red blood cells D. Size of red blood cells E. Patency and responsiveness of the blood vessels

A. Efficiency of heart as a pump B. Adequacy of circulating blood volume E. Patency and responsiveness of the blood vessels Rationale: Adequate blood flow depends on the efficiency of the heart as a pump, the patency and responsiveness of the blood vessels, and the adequacy of circulating blood volume. Adequacy of blood flow does not primarily depend on the size of red cells or their ratio to the number of platelets.

The nurse is planning care for a client with venous insufficiency. Which nursing intervention would be appropriate for this client's plan of care? A. Elevate lower extremities. B. Educate on decreased protein. C. Apply compression only at night. D. Teach frequent rest periods due to pain.

A. Elevate lower extremities. Rationale: Venous insufficiency is lack of blood flow back to the heart. Elevation of lower extremities will assist the peripheral blood vessels in returning stasis of blood. Increased protein should be taught. Compression therapy should be used but not only at night. Pain is not usually assessed in clients with venous insufficiency but with arterial insufficiency.

A client with advanced venous insufficiency is confined to bed rest following orthopedic surgery. How can the nurse best prevent skin breakdown in the client's lower extremities? A. Ensure that the client's heels are protected and supported. B. Closely monitor the client's serum albumin and prealbumin levels. C. Perform gentle massage of the client's lower legs, as tolerated. D. Perform passive range-of-motion exercises once per shift.

A. Ensure that the client's heels are protected and supported. Rationale: If the client is on bed rest, it is important to relieve pressure on the heels to prevent pressure ulcerations, since the heels are among the most vulnerable body regions. Monitoring blood work does not directly prevent skin breakdown, even though albumin is related to wound healing. Massage is not normally indicated and may exacerbate skin breakdown. Passive range-of-motion exercises do not directly reduce the risk of skin breakdown.

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: A. Hemorrhage. B. Thrombosis of the graft. C. Decreased motor function. D. Stent dislodgement.

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

The nurse has performed a thorough nursing assessment of the care of a client with chronic leg ulcers. The nurse's assessment should include which of the following components? Select all that apply. A. Location and type of pain B. Apical heart rate C. Bilateral comparison of peripheral pulses D. Comparison of temperature in the client's legs E. Identification of mobility limitations

A. Location and type of pain C. Bilateral comparison of peripheral pulses D. Comparison of temperature in the client's legs E. Identification of mobility limitations Rationale: A careful nursing history and assessment are important. The extent and type of pain are carefully assessed, as are the appearance and temperature of the skin of both legs. The quality of all peripheral pulses is assessed, and the pulses in both legs are compared. Any limitation of mobility and activity that results from vascular insufficiency is identified. It is not likely that there is any direct indication for assessment of apical heart rate, although peripheral pulses must be assessed.

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? A. Moderate to severe arterial insufficiency B. No arterial insufficiency C. Very mild arterial insufficiency D. Tissue loss to that foot

A. Moderate to severe arterial insufficiency Rationale: 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.

Aortic dissection may be mistaken for which of the following disease processes? A. Myocardial infarction (MI) B. Stroke C. Pneumothorax D. Angina

A. Myocardial infarction (MI) Rationale: Aortic dissection may be mistaken for an acute MI, which could confuse the clinical picture and initial treatment. Aortic dissection is not mistaken for stroke, pneumothorax, or angina.

The nurse is caring for a client with a large venous leg ulcer. What intervention should the nurse implement to promote healing and prevent infection? A. Provide a high-calorie, high-protein diet. B. Apply a clean occlusive dressing once daily and whenever soiled. C. Abstain from wearing graduated compression stockings. D. Apply an antibiotic ointment on the surrounding skin with each dressing change.

A. Provide a high-calorie, high-protein diet. Rationale: Wound healing is highly dependent on adequate nutrition. The diet should be sufficiently high in calories and protein. Antibiotic ointments are not normally used on the skin surrounding a leg ulcer and occlusive dressings can exacerbate impaired blood flow. Compression therapy should be implemented with venous ulcers but not arterial ulcers.

The nurse is caring for a client who is seeking care for signs and symptoms of lymphedema. The nurse's plan of care should prioritize which nursing diagnosis? A. Risk for infection related to lower extremity swelling secondary to lymphedema B. Disturbed body image related to lower extremity swelling secondary to lymphedema C. Ineffective health maintenance related to lower extremity swelling secondary to lymphedema D. Risk for deficient fluid volume related to lower extremity swelling secondary to lymphedema

A. Risk for infection related to lower extremity swelling secondary to lymphedema Rationale: Lymphedema, which is caused by the accumulation of lymph in the tissues, constitutes a significant risk for infection. The client's body image is likely to be disturbed, and the nurse should address this, but infection is a more significant threat to the client's physiologic well-being. Lymphedema is unrelated to ineffective health maintenance and deficient fluid volume is not a significant risk.

Which of the following are alterations noted in Virchow's triad? Select all that apply. A. Stasis of blood B. Vessel wall injury C. Altered coagulation D. Edema E. Tenderness

A. Stasis of blood B. Vessel wall injury C. Altered coagulation Rationale: Three factors, known as Virchow's triad, are believed to play a significant role in the development of venous thrombosis. They are stasis of blood, vessel wall injury, and altered coagulation. Edema and tenderness are clinical manifestations of venous thrombosis, but are not part of the triad.

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? A. Taking daily walks B. Engaging in anaerobic exercise C. Reducing daily fat intake to less than 45% of total calories D. Abstaining from foods that increase levels of high-density lipoproteins (HDLs)

A. Taking daily walks Rationale: Taking daily walks relieves symptoms of intermittent claudication, although the exact mechanism is unclear. Anaerobic exercise may make these symptoms worse. Clients with chronic arterial occlusive disease must reduce daily fat intake to 30% or less of total calories. The client should limit dietary cholesterol because hyperlipidemia is associated with atherosclerosis, a known cause of arterial occlusive disease. However, HDLs have the lowest cholesterol concentration, so this client should eat, not abstain from, foods that raise HDL levels.

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

A. Teach the client how to apply a graduated compression stocking. Rationale: In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the client how to apply a graduated compression stocking. The nurse informs the physician if the client's temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

What should the nurse do to manage the persistent swelling in a client with severe lymphangitis and lymphadenitis? A. Teach the client how to apply an elastic sleeve B. Inform the physician if the client's temperature remains low C. Avoid elevating the area D. Offer cold applications to promote comfort and to enhance circulation

A. Teach the client how to apply an elastic sleeve Rationale: In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the client how to apply an elastic sleeve or stocking. The nurse informs the physician if the client's temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

The most common site of aneurysm formation is in the: A. abdominal aorta, just below the renal arteries. B. ascending aorta, around the aortic arch. C. descending aorta, beyond the subclavian arteries. D. aortic arch, around the ascending and descending aorta.

A. abdominal aorta, just below the renal arteries. Rationale: About 75% of aneurysms occur in the abdominal aorta, just below the renal arteries (Debarked type I aneurysms). Debarked type II aneurysms occur in the aortic arch around the ascending and descending aorta, whereas Debarked type III aneurysms occur in the descending aorta, beyond the subclavian arteries.

Heparin therapy is usually considered therapeutic when the activated partial thromboplastin time (aPTT) is how many times higher than a normal value? A. 0.5 to 1.5 B. 1.5 to 2.5 C. 2.5 to 3.5 D. 3.5 to 4.5

B. 1.5 to 2.5 Rationale: Heparin therapy is usually considered therapeutic when the aPTT is 1.5 to 2.5 times the normal aPTT value. The other values are not within therapeutic range.

The nurse is caring for a client with Raynaud's disease. What are important instructions for a client who is diagnosed with this disease to prevent an attack? A. Report changes in the usual pattern of chest pain. B. Avoid situations that contribute to ischemic episodes. C. Avoid fatty foods and exercise. D. Take over-the-counter decongestants.

B. Avoid situations that contribute to ischemic episodes. Rationale: Teaching for clients with Raynaud's disease and their family members is important. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.

A nurse in a long-term care facility is caring for an 83-year-old client who has a history of heart failure (HF) and peripheral arterial disease (PAD). At present, the client is unable to stand or ambulate. The nurse should implement measures to prevent which complication? A. Aortitis B. Deep vein thrombosis C. Thoracic aortic aneurysm D. Raynaud disease

B. Deep vein thrombosis Rationale: Although the exact cause of venous thrombosis remains unclear, three factors, known as Virchow triad, are believed to play a significant role in its development: stasis of blood (venous stasis), vessel wall injury, and altered blood coagulation. This client has venous stasis from immobility, vessel wall injury from PAD, and altered blood coagulation from HF. The cause of aortitis is unknown, but it has no direct connection to HF, PAD, or mobility issues. The greatest risk factors for thoracic aortic aneurysm are atherosclerosis and hypertension; there is no direct connection to HF, PAD, or mobility issues. Raynaud disease is a disorder that involves spasms of blood vessels and, again, no direct connection to HF, PAD, or mobility issues.

The nurse knows which diagnostic test is used to document the anatomic site of reflux and provides a quantitative measure of the severity of valvular reflux? A. Contrast phlebography B. Duplex ultrasound scan C. Lymphangiography D. Lymphoscintigraphy

B. Duplex ultrasound scan Rationale: Diagnostic tests for varicose veins include the duplex ultrasound scan, which documents the anatomic site of reflux and provides a quantitative measure of the severity of valvular reflux. Contrast phlebography involves injecting a radiopaque contrast agent into the venous system. Lymphoscintigraphy is done when a radioactively labeled colloid is injected subcutaneously in the second interdigital space. The extremity is then exercised to facilitate the uptake of the colloid by the lymphatic system, and serial images are obtained at preset intervals. Lymphangiography provides a way to detect lymph node involvement resulting from metastatic carcinoma, lymphoma, or infection in sites that are otherwise inaccessible to the examiner except by surgery.

A nurse has written a plan of care for a client diagnosed with peripheral arterial insufficiency. One of the nursing diagnoses in the care plan is altered peripheral tissue perfusion related to compromised circulation. Which intervention is the most appropriate for this diagnosis? A. Elevate the legs and arms above the heart when resting. B. Encourage the client to engage in a moderate amount of exercise. C. Encourage extended periods of sitting or standing. D. Discourage walking in order to limit pain.

B. Encourage the client to engage in a moderate amount of exercise. Rationale: The nursing diagnosis of altered peripheral tissue perfusion related to compromised circulation requires interventions that focus on improving circulation. Encouraging the client to engage in a moderate amount of exercise serves to improve circulation. Elevating the client's legs and arms above the heart when resting would be passive and fails to promote circulation. Encouraging long periods of sitting or standing would further compromise circulation. The nurse should encourage, not discourage, walking to increase circulation and decrease pain.

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? A. Metoprolol (Lopressor) B. Epinephrine C. Hydrocortisone (Solu-Cortef) D. Cimetidine (Tagamet)

B. Epinephrine Rationale: Infrequently, a patient may have an immediate or delayed allergic reaction to the iodine contained in the contrast agent used in angiography. Manifestations include dyspnea, nausea and vomiting, sweating, tachycardia, and numbness of the extremities. Any such reaction must be reported to the interventionalist at once; treatment may include the administration of epinephrine, antihistamines, or corticosteroids.

A client with lower extremity edema is diagnosed with lymphedema. For which medication will the nurse prepare teaching for this client? A. Oxycodone B. Furosemide C. Amoxicillin D. Heparin

B. Furosemide Rationale: Lymphedema may be primary (congenital malformations) or secondary (acquired obstructions). Tissue swelling occurs in the extremities because of an increased quantity of lymph that results from obstruction of lymphatic vessels. As initial therapy, the diuretic furosemide may be prescribed to prevent fluid overload due to mobilization of extracellular fluid. Opioids are not used to treat lymphedema. Antibiotics would be prescribed only if an infection is present. Anticoagulants are not used to treat lymphedema.

The nurse is caring for a client who is admitted to the medical unit for the treatment of a venous ulcer in the area of the lateral malleolus that has been unresponsive to treatment. Which finding is the nurse most likely to identify during an assessment of this client's wound? A. Hemorrhage B. Heavy exudate C. Deep wound bed D. Pale-colored wound bed

B. Heavy exudate Rationale: Venous ulcerations in the area of the medial or lateral malleolus (gaiter area) are typically large, superficial, and highly exudative. Venous hypertension causes extravasation of blood, which discolors the area of the wound bed. Bleeding is not normally present.

While assessing a client, the nurse notes that the client's ankle-brachial index (ABI) of the right leg is 0.40. How should the nurse best follow up this assessment finding? A. Assess the client's use of over-the-counter dietary supplements. B. Implement interventions relevant to arterial narrowing. C. Encourage the client to increase intake of foods high in vitamin K. D. Adjust the client's activity level to accommodate decreased coronary output.

B. Implement interventions relevant to arterial narrowing. Rationale: ABI is used to assess the degree of stenosis of peripheral arteries. An ABI of less than 1.0 indicates possible claudication of the peripheral arteries. It does not indicate inadequate coronary output. There is no direct indication for changes in vitamin K intake and over-the-counter (OTC) medications are not likely causative.

The nurse is caring for a client who is diagnosed with Raynaud phenomenon. The nurse should plan interventions to address which nursing diagnosis? A. Chronic pain B. Ineffective tissue perfusion C. Impaired skin integrity D. Risk for injury

B. Ineffective tissue perfusion Rationale: Raynaud phenomenon is a form of intermittent arteriolar vasoconstriction resulting in inadequate tissue perfusion. This results in coldness, pain, and pallor of the fingertips or toes. Pain is typically intermittent and acute, not chronic, and skin integrity is rarely at risk. In most cases, the client is not at a high risk for injury.

A postsurgical client has illuminated the call light to inform the nurse of a sudden onset of lower leg pain. On inspection, the nurse observes that the client's left leg is visibly swollen and reddened. Which action by the nurse would be most appropriate? A. Administer a PRN dose of subcutaneous heparin. B. Inform the health care provider that the client has signs and symptoms of venous thromboembolism (VTE). C. Mobilize the client promptly to dislodge any thrombi in the client's lower leg. D. Massage the client's lower leg to temporarily restore venous return.

B. Inform the health care provider that the client has signs and symptoms of venous thromboembolism (VTE). Rationale: VTE requires prompt medical follow-up. Heparin will not dissolve an established clot. Massaging the client's leg and mobilizing the client would be contraindicated because they would dislodge the clot, possibly resulting in a pulmonary embolism.

The nurse is taking a health history of a new client who reports pain in the left lower leg and foot when walking. This pain is relieved with rest, and the nurse observes that the left lower leg is slightly edematous and is hairless. When planning this client's care, the nurse should most likely address which health problem? A. Coronary artery disease (CAD) B. Intermittent claudication C. Arterial embolus D. Raynaud disease

B. Intermittent claudication Rationale: A muscular, cramp-type pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest is experienced by clients with peripheral arterial insufficiency. Referred to as intermittent claudication, this pain is caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients and oxygen during exercise. The nurse would not suspect the client has CAD, arterial embolus, or Raynaud disease; none of these health problems produce this cluster of signs and symptoms.

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? A. Phytonadione (vitamin K) B. Protamine sulfate C. Thrombin D. Plasma protein fraction

B. Protamine sulfate Rationale: 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.

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? A. Surgical debridement B. Nonselective debridement C. Enzymatic debridement D. Selective debridement

B. Nonselective debridement Rationale: 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.

While receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? A. Decrease the heparin infusion rate. B. Prepare to administer protamine sulfate. C. Monitor the partial thromboplastin time (PTT). D. Start an I.V. infusion of dextrose 5% in water (D5W).

B. Prepare to administer protamine sulfate. Rationale: Frank hematuria indicates excessive anticoagulation and bleeding — and heparin overdose. The nurse should discontinue the heparin infusion immediately and prepare to administer protamine sulfate, the antidote for heparin. Decreasing the heparin infusion rate wouldn't prevent further bleeding. Although the nurse should continue to monitor PTT, this action should occur later. An I.V. infusion of D5W may be administered, but only after protamine has been given.

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? A. Peripheral vascular disease B. Raynaud's disease C. Arterial occlusive diseases D. Buerger's disease

B. Raynaud's disease Rationale: Raynaud's disease results from reduced blood flow to the extremities when exposed to cold or stress. It's commonly associated with connective tissue disorders such as SLE. Signs and symptoms include pallor, coldness, numbness, throbbing pain, and cyanosis. Peripheral vascular disease results from a reduced blood supply to the tissues. It occurs in the arterial or venous system. Build-up of plaque in the vessels or changes in the vessels results in reduced blood flow, causing pain, edema, and hair loss in the affected extremity. Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches that interrupts blood flow to the legs and feet, causing pain and coolness. Buerger's disease is an inflammatory, nonatheromatous occlusive disease that causes segmental lesions and subsequent thrombus formation in arteries, resulting in decreased blood flow to the feet and legs.

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? A. History of increased aspirin use B. Recent pelvic surgery C. An active daily walking program D. A history of diabetes mellitus

B. Recent pelvic surgery Rationale: The client shows signs of deep vein thrombosis (DVT). The pelvic area has a rich blood supply, and thrombophlebitis of the deep veins is associated with pelvic surgery. Aspirin, an antiplatelet agent, and an active walking program help decrease the client's risk of DVT. In general, diabetes mellitus is a contributing factor associated with peripheral vascular disease.

An occupational health nurse is providing an educational event and has been asked by an administrative worker about the risk of varicose veins. Which action should the nurse suggest as a preventive measure for varicose veins? A. Sit with crossed legs for a few minutes each hour to promote relaxation. B. Walk for several minutes every hour to promote circulation. C. Elevate the legs when tired. D. Wear snug-fitting ankle socks to decrease edema.

B. Walk for several minutes every hour to promote circulation. Rationale: A proactive approach to preventing varicose veins would be to walk for several minutes every hour to promote circulation. Sitting with crossed legs may promote relaxation, but it is contraindicated for clients with, or at risk for, varicose veins. Elevating the legs only helps blood passively return to the heart and does not help maintain the competency of the valves in the veins. Wearing tight ankle socks is contraindicated for clients with, or at risk for, varicose veins; socks that are below the muscles of the calf do not promote venous return the socks simply capture the blood and promote venous stasis.

A medical nurse has admitted four clients over the course of a 12-hour shift. For which client would assessment of ankle-brachial index (ABI) be most clearly warranted? A. A client who has peripheral edema secondary to chronic heart failure B. An older adult client who has a diagnosis of unstable angina C. A client with poorly controlled type 1 diabetes who is a smoker D. A client who has community-acquired pneumonia and a history of COPD

C. A client with poorly controlled type 1 diabetes who is a smoker Rationale: Nurses should perform a baseline ABI on any client with decreased pulses or any client 50 years of age or older with a history of diabetes or smoking. The other answers do not apply.

A nurse on a medical unit is caring for a client who has been diagnosed with lymphangitis. When reviewing this client's medication administration record, the nurse should anticipate which type of medication? A. An anticoagulant B. A diuretic C. An antibiotic D. An antiplatelet aggregator

C. An antibiotic Rationale: Lymphangitis is an acute inflammation of the lymphatic channels caused by an infectious process. Antibiotics are always a component of treatment. Diuretics are of nominal use. Anticoagulants and antiplatelet aggregators are not indicated in this form of infection.

The triage nurse in the emergency department is assessing a client who reports pain and swelling in the right lower leg. The client's pain became much worse last night and appeared along with fever, chills, and sweating. The client states, "I hit my leg on the car door 4 or 5 days ago, and it has been sore ever since." The client has a history of chronic venous insufficiency. Which intervention should the nurse anticipate for this client? A. Platelet transfusion to treat thrombocytopenia B. Warfarin to treat arterial insufficiency C. Antibiotics to treat cellulitis D. Intravenous heparin to treat venous thromboembolism (VTE)

C. Antibiotics to treat cellulitis Rationale: Cellulitis is the most common infectious cause of limb swelling. The signs and symptoms include acute onset of swelling, localized redness, and pain; it is frequently associated with systemic signs of fever, chills, and sweating. The client may be able to identify a trauma that accounts for the source of infection. Thrombocytopenia is a loss or decrease in platelets and increases a client's risk of bleeding; this problem would not cause these symptoms. Arterial insufficiency would present with ongoing pain related to activity. This client does not have signs and symptoms of VTE.

A 79-year-old client is admitted to the medical unit with digital gangrene. The client reports that the problem first began when the client stubbed the toe going to the bathroom in the dark. In addition to this trauma, the nurse should suspect that the client has a history of which health problem? A. Raynaud phenomenon B. Coronary artery disease (CAD) C. Arterial insufficiency D. Varicose veins

C. Arterial insufficiency Rationale: Arterial insufficiency may result in gangrene of the toe (digital gangrene), which usually is caused by trauma. The toe is stubbed and then turns black. Raynaud disease, CAD, and varicose veins are not the usual causes of digital gangrene in older adults.

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? A. Check for the presence of tortuous veins bilaterally on the legs. B. Ask about any changes in skin color that occur in response to cold. C. Attempt to palpate the dorsalis pedis and posterior tibial pulses. D. Assess for unilateral swelling and tenderness of either leg.

C. Attempt to palpate the dorsalis pedis and posterior tibial pulses. Rationale: 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.

How should the nurse best position a client who has leg ulcers that are venous in origin? A. Keep the client's legs flat and straight. B. Keep the client's knees bent to a 45-degree angle and supported with pillows. C. Elevate the client's lower extremities. D. Dangle the client's legs over the side of the bed.

C. Elevate the client's lower extremities. Rationale: Positioning of the legs depends on whether the ulcer is of arterial or venous origin. With ulcers of venous origin, the lower extremities should be elevated to avoid dependent edema. Simply bending the knees to a 45-degree angle would not prevent dependent edema, as they must be elevated above the level of the heart. Dangling the client's legs and applying pillows may further compromise venous return.

The nurse is preparing to administer warfarin to a client with deep vein thrombophlebitis. Which laboratory value would most clearly indicate that the client's warfarin is at therapeutic levels? A. Partial thromboplastin time (PTT) within normal reference range B. Prothrombin time (PT) 8 to 10 times the control C. International normalized ratio (INR) between 2 and 3 D. Hematocrit of 32%

C. International normalized ratio (INR) between 2 and 3 Rationale: The INR is most often used to determine whether warfarin is at a therapeutic level; an INR of 2 to 3 is considered therapeutic. Warfarin is also considered to be at therapeutic levels when the client's PT is 1.5 to 2 times the control. Higher values indicate increased risk of bleeding and hemorrhage, whereas lower values indicate increased risk of blood clot formation. Heparin, not warfarin, prolongs PTT. Hematocrit does not provide information on the effectiveness of warfarin; however, a falling hematocrit in a client taking warfarin may be a sign of hemorrhage.

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? A. Activated partial thromboplastin time (aPPT) is half of the control value B. Prothrombin time (PT) is 0.5 times normal. C. International normalized ratio (INR) is 2.5. D. K+ level is 3.5.

C. International normalized ratio (INR) is 2.5. Rationale: Oral anticoagulants such as warfarin are monitored by PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0)

The nurse is caring for an acutely ill client who is on a factor Xa inhibitor. The client has a comorbidity of renal insufficiency. How will this client's renal status affect this anticoagulant therapy? A. The factor Xa inhibitor is contraindicated in the treatment of this client. B. The factor Xa inhibitor may be given subcutaneously, but not intravenously (IV). C. Lower doses of factor Xa inhibitor are required for this client. D. Warfarin will be substituted for the factor Xa inhibitor.

C. Lower doses of factor Xa inhibitor are required for this client. Rationale: If renal insufficiency exists, lower doses, not contraindication, of factor Xa inhibitors are needed. Warfarin is not an acceptable substitution for this type of medication. There is no contraindication for IV administration.

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? A. Decreasing blood pressure and increasing mobility B. Increasing blood pressure and reducing mobility C. Stabilizing heart rate and blood pressure and easing anxiety D. Increasing blood pressure and monitoring fluid intake and output

C. Stabilizing heart rate and blood pressure and easing anxiety Rationale: For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse should take measures to lower blood pressure, such as administering antihypertensive agents, as ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's mobility individually, most clients need bed rest when initially attempting to gain stability.

A nurse is closely monitoring a client who has recently been diagnosed with an abdominal aortic aneurysm. What assessment finding would signal an impending rupture of the client's aneurysm? A. Sudden increase in blood pressure and a decrease in heart rate B. Cessation of pulsating in an aneurysm that has previously been pulsating visibly C. Sudden onset of severe back or abdominal pain D. New onset of hemoptysis

C. Sudden onset of severe back or abdominal pain Rationale: Signs of impending rupture include severe back or abdominal pain, which may be persistent or intermittent. Impending rupture is not typically signaled by increased blood pressure, bradycardia, cessation of pulsing, or hemoptysis.

A nurse in the rehabilitation unit is caring for an older adult client who is in cardiac rehabilitation following an MI. The nurse's plan of care calls for the client to walk for 10 minutes 3 times a day. The client questions the relationship between walking and heart function. How should the nurse best reply? A. "The arteries in your legs constrict when you walk and allow the blood to move faster and with more pressure on the tissue." B. "Walking increases your heart rate and blood pressure. Therefore, your heart is under less stress." C. "Walking helps your heart adjust to your new arteries and helps build your self-esteem." D. "When you walk, the muscles in your legs contract and pump the blood in your veins back toward your heart, which allows more blood to return to your heart."

D. "When you walk, the muscles in your legs contract and pump the blood in your veins back toward your heart, which allows more blood to return to your heart." Rationale: Veins, unlike arteries, are equipped with valves that allow blood to move against the force of gravity. The legs have one-way bicuspid valves that prevent blood from seeping backward as it moves forward by the muscles in our legs pressing on the veins as we walk and increasing venous return. Leg arteries do constrict when walking, which allows the blood to move faster and with more pressure on the tissue, but the greater concern is increasing the flow of venous blood to the heart. Walking increases, not decreases, the heart's pumping ability, which increases heart rate and blood pressure and the heart's ability to manage stress. Walking does help the heart adjust to new arteries and may enhance self-esteem, but the client had an MI—there are no "new arteries."

An older adult client has been treated for a venous ulcer and a plan is in place to prevent the occurrence of future ulcers. What should the nurse include in this plan? A. Use of supplementary oxygen to aid tissue oxygenation B. Daily use of normal saline compresses on the lower limbs C. Daily administration of prophylactic antibiotics D. A high-protein diet that is rich in vitamins

D. A high-protein diet that is rich in vitamins Rationale: A diet that is high in protein, vitamins C and A, iron, and zinc is encouraged to promote healing and prevent future ulcers. Prophylactic antibiotics and saline compresses are not used to prevent ulcers. Oxygen supplementation does not prevent ulcer formation.

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? A. Within 12 hours B. Within the first 24 hours C. In 2 days D. In 3 to 5 days

D. In 3 to 5 days Rationale: Oral anticoagulants, such as warfarin, are monitored by the PT or the INR. Because the full anticoagulant effect of warfarin is delayed for 3 to 5 days, it is usually administered concurrently with heparin until desired anticoagulation has been achieved (i.e., when the PT is 1.5 to 2 times normal or the INR is 2.0 to 3.0) (Holbrook et al., 2012).

The nurse is assessing a client with severe hypertension. Which symptom indicates to the nurse that the client is experiencing dissection of the aorta? A. Numbness and pain of the left arm B. Pain when flexing the neck forward C. Gradual onset of a frontal headache D. A ripping sensation in the chest

D. A ripping sensation in the chest Rationale: Aortic dissections are commonly associated with poorly controlled hypertension. Dissection is caused by rupture in the intimal layer. A rupture may occur through adventitia or into the lumen through the intima, allowing blood to reenter the main channel and resulting in chronic dissection or occlusion of branches of the aorta. The onset of symptoms is usually sudden and described as severe, persistent pain that feels like tearing or ripping. An aortic dissection does not cause pain and numbness of the left arm. Pain when flexing the neck forward is not associated with an aortic dissection. An aortic dissection does not cause a headache.

To assess the dorsalis pedis artery, the nurse would use the tips of three fingers and apply light pressure to the: A. Inside of the ankle just above the heel. B. Exterior surface of the foot near the heel. C. Outside of the foot just below the heel. D. Anterior surface of the foot near the ankle joint.

D. Anterior surface of the foot near the ankle joint. Rationale: The dorsalis pedis pulse can be palpated on the dorsal surface of the foot distal to the major prominence of the navicular bone.

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? A. Doppler ultrasound B. Magnetic resonance angiography (MRA) C. Angiography D. Computed tomography angiography (CTA)

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

Which statement is accurate regarding Raynaud disease? A. The disease generally affects the client trilaterally. B. It affects more than two digits on each hand or foot. C. It is most common in men 16 to 40 years of age. D. Episodes may be triggered by unusual sensitivity to cold.

D. Episodes may be triggered by unusual sensitivity to cold. Rationale: Episodes of Raynaud 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 nurse caring for a client with a leg ulcer has finished assessing the client and is developing a problem list prior to writing a plan of care. What priority risk would the care plan address? A. Disuse syndrome B. Ineffective health maintenance C. Sedentary lifestyle D. Insufficient nutrition

D. Insufficient nutrition Rationale: The client with leg ulcers is at risk for insufficient nutrition related to the increased need for nutrients that promote wound healing. The risk for disuse syndrome is a state in which an individual is at risk for deterioration of body systems owing to prescribed or unavoidable musculoskeletal inactivity. A leg ulcer will affect activity, but rarely to this degree. Leg ulcers are not necessarily a consequence of ineffective health maintenance or a sedentary lifestyle.

A client comes to the walk-in clinic with reports of pain in the foot following stepping on a roofing nail 4 days ago. The client has a visible red streak running up his foot and ankle. Which health problem should the nurse suspect? A. Cellulitis B. Local inflammation C. Elephantiasis D. Lymphangitis

D. Lymphangitis Rationale: Lymphangitis is an acute inflammation of the lymphatic channels. It arises most commonly from a focus of infection in an extremity. Usually, the infectious organism is hemolytic streptococcus. The characteristic red streaks that extend up the arm or the leg from an infected wound outline the course of the lymphatic vessels as they drain. Cellulitis is caused by bacteria, which cause a generalized edema in the subcutaneous tissues surrounding the affected area. Local inflammation would not present with red streaks in the lymphatic channels. Elephantiasis is transmitted by mosquitoes that carry parasitic worm larvae; the parasites obstruct the lymphatic channels and results in gross enlargement of the limbs.

A nurse working in a long-term care facility is performing the admission assessment of a newly admitted 85-year-old resident. During inspection of the resident's feet, the nurse notes early evidence of gangrene on one of the resident's great toes. The nurse should assess for further evidence of which health problem? A. Chronic venous insufficiency B. Raynaud phenomenon C. Venous thromboembolism (VTE) D. Peripheral artery disease (PAD)

D. Peripheral artery disease (PAD) Rationale: In older adults, symptoms of PAD may be more pronounced than in younger people. In older adult clients who are inactive, gangrene may be the first sign of disease. Venous insufficiency does not normally manifest with gangrene. Similarly, VTE and Raynaud phenomenon do not cause the ischemia that underlies gangrene.

The nurse is assessing a woman who is pregnant at 27 weeks' gestation. The client is concerned about the recent emergence of varicose veins on the backs of her calves. What is the nurse's best action? A. Facilitate a referral to a vascular surgeon. B. Assess the client's ankle-brachial index (ABI) and perform Doppler ultrasound testing. C. Encourage the client to increase her activity level. D. Teach the client that circulatory changes during pregnancy frequently cause varicose veins.

D. Teach the client that circulatory changes during pregnancy frequently cause varicose veins. Rationale: Pregnancy may cause varicosities because of hormonal effects related to decreased venous outflow, increased pressure by the gravid uterus, and increased blood volume. In most cases, no intervention or referral is necessary. This finding is not an indication for ABI assessment and increased activity will not likely resolve the problem.

A nurse is reviewing the physiologic factors that affect a client's cardiovascular health and tissue oxygenation. What is the systemic arteriovenous oxygen difference? A. The average amount of oxygen removed by each organ in the body B. The amount of oxygen removed from the blood by the heart C. The amount of oxygen returning to the lungs via the pulmonary artery D. The amount of oxygen in aortic blood minus the amount of oxygen in the vena caval blood

D. The amount of oxygen in aortic blood minus the amount of oxygen in the vena caval blood Rationale: The average amount of oxygen removed collectively by all of the body tissues is about 25%. This means that the blood in the vena cava contains about 25% less oxygen than aortic blood. This is known as the systemic arteriovenous oxygen difference. The other answers do not apply.

Graduated compression stockings have been prescribed to treat a client's venous insufficiency. What education should the nurse prioritize when introducing this intervention to the client? A. The need to take anticoagulants concurrent with using compression stockings B. The need to wear the stockings on a "one day on, one day off" schedule C. The importance of wearing the stockings around the clock to ensure maximum benefit D. The importance of ensuring the stockings are applied evenly with no pressure points

D. The importance of ensuring the stockings are applied evenly with no pressure points Rationale: Any type of stocking can inadvertently become a tourniquet if applied incorrectly (i.e., rolled tightly at the top). In such instances, the stockings produce rather than prevent stasis. For ambulatory clients, graduated compression stockings are removed at night and reapplied before the legs are lowered from the bed to the floor in the morning. They are used daily, not on alternating days. Anticoagulants are not always indicated in clients who are using compression stockings.

A nurse is assessing a new client who is diagnosed with peripheral artery disease. The nurse cannot feel the pulse in the client's left foot. How should the nurse proceed with assessment? A. Have the primary care provider prescribe a computed tomography (CT) scan. B. Apply a tourniquet for 3 to 5 minutes and then reassess. C. Elevate the extremity and attempt to palpate the pulses. D. Use Doppler ultrasound to identify the pulses.

D. Use Doppler ultrasound to identify the pulses. Rationale: When pulses cannot be reliably palpated, a hand-held continuous wave Doppler ultrasound device may be used to hear (insonate) the blood flow in vessels. CT is not normally warranted, and the application of a tourniquet poses health risks and will not aid assessment. Elevating the extremity would make palpation more difficult.

The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise: A. reduces stress. B. aids in weight reduction. C. increases high-density lipoprotein (HDL) level. D. decreases venous congestion.

D. decreases venous congestion. Rationale: Regular walking is the best way to decrease venous congestion because using the leg muscles as a pump helps return blood to the heart. Regular exercise also aids in stress reduction and weight reduction and increases the formation of HDLs — which are all beneficial to a client with peripheral vascular disease. However, these changes don't have as significant an effect on the client's condition as decreasing venous congestion.