Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation

A nurse is changing a dressing on an arterial suture site. The site is red, with foul-smelling drainage. Based on these symptoms, the nurse is aware to monitor for which type of aneurysm? a) False b) Dissecting c) Anastomotic d) Saccular

Answer: Anastomotic

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

Answer: "I stopped smoking and use only chewing tobacco."

A community health nurse teaches a group of seniors 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 of the following statements? a) "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet." b) "Since my family is from Italy, I have a higher risk of developing peripheral arterial disease." c) "The older I get the higher my risk for peripheral arterial disease gets." d) "I will need to increase the amount of green leafy vegetables I eat to lower my cholesterol levels."

Answer: "I will need to stop smoking because the nicotine causes less blood to flow to my hands and feet."

A nurse suspects the presence of an abdominal aortic aneurysm. What assessment data would the nurse correlate with a diagnosis of abdominal aortic aneurysm? (Select all that apply.) a) A pulsatile abdominal mass b) Diarrhea c) Low back pain d) Decreased bowel sounds e) Lower abdominal pain

Answer: A, C, E Rationale: Some patients complain that they can feel their heart beating in their abdomen when lying down, or they may say that they feel an abdominal mass or abdominal throbbing. The most important diagnostic indication of an abdominal aortic aneurysm is a pulsatile mass in the middle and upper abdomen. Signs of impending aneurysm rupture include severe back or abdominal pain, which may be persistent or intermittent. Abdominal pain is often localized in 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.

The nurse is educating a patient with chronic venous insufficiency about prevention of complications related to the disorder. What should the nurse include in the information given to the patient? (Select all that apply.) a) Sit on the side of the bed and dangle the feet. b) Sit as much as possible to rest the valves in the legs. c) Sleep with the foot of the bed elevated about 6 inches. d) Avoid constricting garments. e) Elevate the legs above the heart level for 30 minutes every 2 hours.

Answer: C, D, E Rationale: Elevating the legs decreases edema, promotes venous return, and provides symptomatic relief. The legs should be elevated frequently throughout the day (at least 15 to 20 minutes four times daily). At night, the patient should sleep with the foot of the bed elevated about 15 cm (6 inches). Prolonged sitting or standing in one position is detrimental; walking should be encouraged. When sitting, the patient should avoid placing pressure on the popliteal spaces, as occurs when crossing the legs or sitting with the legs dangling over the side of the bed. Constricting garments, especially socks that are too tight at the top or that leave marks on the skin, should be avoided.

The nurse performing an assessment on a patient who has arterial insufficiency of the legs and an ulcer on the left great toe would expect to find which of the following characteristics? a) Pulses are present, may be difficult to palpate b) Superficial ulcer c) Aching, cramping pain d) Diminished or absent pulses

Answer: Diminished or absent pulses

Which of the following aneurysms results in bleeding into the layers of the arterial wall? a) Dissecting b) Saccular c) False d) Anastomotic

Answer: Dissecting

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? a) Avoid foods with iodine. b) Elevate the legs periodically for at least 15 to 20 minutes. c) Refrain from sexual activity for a week. d) Elevate the legs periodically for at least an hour.

Answer: Elevate the legs periodically for at least 15 to 20 minutes.

Which of the following is accurate regarding Raynaud's disease? a) It is generally bilateral. b) It affects more than two digits on each hand or foot. c) Episodes may be triggered by unusual sensitivity to cold. d) It is most common in men aged 16 to 40 years.

Answer: Episodes may be triggered by unusual sensitivity to cold. Rationale: Episodes of Raynaud's disease may be triggered by emotional factors or by unusual sensitivity to cold. The disease is most common in women between the ages of 16 and 40. It is generally unilateral and affects only one or two digits.

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) Thrombosis of the graft. b) Decreased motor function. c) Stent dislodgement. d) Hemorrhage.

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

A client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test validates presence of thromboembolism? a) Rinne b) Phalen's c) Romberg's d) Homans'

Answer: Homan's

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

Answer: Ineffective peripheral tissue perfusion related to venous congestion

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? a) Acute limb ischemia b) Dizziness c) Vertigo d) Intermittent claudication

Answer: Intermittent claudication

A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment? a) Numbness, cool skin temperature, and pallor b) Redness, cool skin temperature, and swelling c) Numbness, warm skin temperature, and redness d) Swelling, warm skin temperature, and drainage

Answer: Numbness, cool skin temperature, and pallor Rationale: Signs and symptoms of impaired circulation include numbness and cool, pale skin. Signs of localized infection may include swelling, drainage, redness, and warm skin. Signs of adequate circulation include normal sensation and warm skin with normal return of skin color after blanching.

Which of the following are risk factors for venous disorders of the lower extremities? a) Obesity b) Surgery c) Trauma d) Pacing wires

Answer: Obesity Rationale: Careful assessment is invaluable in detecting early signs of venous disorders of the lower extremities. Patients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk. Other patients at high risk include those who are obese or older adults and women taking oral contraceptives.

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

Answer: Participate in a regular walking program

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) Raynaud's disease b) Arterial occlusive diseases c) Buerger's disease d) Peripheral vascular disease

Answer: Raynaud's disease

Which of the following is the most effective intervention for preventing progression of vascular disease? a) Use neutral soaps b) Avoid trauma c) Wear sturdy shoes d) Risk factor modification

Answer: Risk factor modification

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) Increasing blood pressure and reducing mobility b) Stabilizing heart rate and blood pressure and easing anxiety c) Decreasing blood pressure and increasing mobility d) Increasing blood pressure and monitoring fluid intake and output

Answer: 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 providing education about the prevention of arterial constriction to a client with peripheral arterial disease. Which of the following includes priority information the nurse would give to the client? a) Wear antiembolytic stockings daily to assist with blood return to the heart. b) Keep your feet elevated above your heart. c) Stop smoking. d) Do not cross your legs for more than 30 minutes at a time.

Answer: Stop smoking.

What should the nurse do to manage the persistent swelling in a patient with severe lymphangitis and lymphadenitis? a) Teach the patient how to apply a graduated compression stocking. b) Avoid elevating the area. c) Offer cold applications to promote comfort and to enhance circulation. d) Inform the physician if the temperature remains low.

Answer: Teach the patient how to apply a graduated compression stocking.

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

Answer: The client experiences shortness of breath after walking about 50 feet.

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

Answer: The client is at risk for heparin-induced thrombocytopenia; therefore, the care plan should include reporting evidence of bleeding or easy bruising.

The nurse is caring for a patient with venous insufficiency. What should the nurse assess the patient's lower extremities for? a) Ulceration b) Dermatitis c) Rudor d) Cellulitis

Answer: Ulceration

What are the symptoms a nurse should assess for in a patient with lymphedema as a result of impaired nutrition to the tissue? a) Loose and wrinkled skin b) Evident scaring c) Ulcers and infection in the edematous area d) Cyanosis

Answer: Ulcers and infection in the edematous area

The nurse teaches the patient with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes which of the following? a) Depression of the cough reflex b) Diuresis c) Slowed heart rate d) Vasospasm

Answer: Vasospasm Rationale: Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities. Tobacco smoke also impairs transport and cellular use of oxygen and increases blood viscosity. Patients with arterial insufficiency who smoke or chew tobacco must be fully informed of the effects of nicotine on circulation and be encouraged to stop.

The term for a diagnostic test that involves injection of a contrast media into the venous system through a dorsal vein in the foot is a) a lymphangiography. b) a contrast phlebography. c) an air plethysmography. d) a lymphoscintigraphy.

Answer: a contrast phlebography

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

Answer: forcing blood into the deep venous system. Rationale: 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.