Nursing Care of Patients with Vascular Diseases

A patient with hypertension weighing 115 kg is advised by the primary healthcare provider to lose​ 10% of total body weight over the next 6 months. How many lbs. of weight loss per month should the nurse instruct the patient to establish as a​ goal?

4 lbs Rationale: The patient weighs 115 kg. To convert this weight into lbs. multiply the weight in kg by 2 lbs. or 115​ × 2​ = 253 lbs. The patient is counseled to lose​ 10% of total body weight or 253 lbs.​ × 10%​ = 23 lbs. If this weight is to be lost over 6​ months, divide the total weight to lose by 6 or​ 23/6 = 216 lbs. When rounding to the nearest whole​ number, the patient should set a goal to lose 4 lbs. per month.

A patient who is being treated for a deep vein thrombosis​ (DVT) complains of chest pain and shortness of breath. What should the nurse do​ first? a. Assess the extremity with the thrombosis. b. Elevate the head of the bed and begin oxygen therapy. c. Assess the pulses on the extremity with the thrombosis. d. Measure the​ patient's blood pressure.

B. Elevate the head of the bed and begin oxygen therapy. ​Rationale: Immediately report patient complaints of chest pain and shortness of​ breath, anxiety, or a sense of impending doom. Prompt intervention to restore pulmonary blood flow can reduce the risk of significant adverse effects. Initiate oxygen therapy and elevate the head of the bed. The other interventions are not the priority and would delay the initiation of required interventions in this situation.

A​ co-worker asks the nurse is to review the following discharge instructions with an assigned patient. Based on the content to be​ reviewed, the nurse should realize that the patient has what health​ problem? a. Buerger disease b. atherosclerosis c. Raynaud disease d. thromboangiitis obliterans

C. Raynaud disease This is the correct answer. ​Rationale: The patient with Raynaud disease has spasms of the small arteries in the digits. There is no specific treatment and the patient is taught to manage the disorder. This includes taking calcium channel blockers such as​ nifedipine, avoiding exposure to cold and​ stress, smoking​ cessation, preventing injuries to the extremities and managing stress. Thromboangiitis obliterans is an inflammatory process manifested by pain and diminished cessation in the extremities. Digits or extremities may be​ pale, cyanotic or​ ruddy, and cool or cold to the touch. There are no specific medications to treat this disorder. Smoking cessation is the one most important component in managing this disorder. Blood flow may be improved by​ exercise, keeping the extremities warm and​ elevated, and avoiding stress. Buerger disease is another name for this disorder. Atherosclerosis involves deposits of​ fat, which result in obstruction and hardening of the arteries. Pain is the primary symptom. Management includes smoking​ cessation, lowering​ cholesterol, managing​ hypertension, controlling​ diabetes, and weight loss.

A patient is recovering from surgery for varicose veins. What information should the nurse include in this​ patient's postoperative​ teaching? Select all that apply. a. Increase ambulation gradually. b. Sit for no more than 1 hour at a time. c. Avoid standing for more than 15 minutes. d. Elevate the extremities. e. Keep pressure dressing applied for 6 weeks.

a. Increase ambulation gradually d. Elevate the extremities. This is the correct answer. e. Keep pressure dressing applied for 6 weeks. This is the correct answer. ​Rationale: Postoperative care for varicose veins includes applying pressure bandages for a minimum of 6​ weeks, elevating the extremities to minimize postoperative​ edema, and gradually increasing amounts of ambulation. Sitting and standing are prohibited during the initial recovery​ period, and are gradually reintroduced as deemed appropriate by the surgeon.

A patient is suspected as having secondary hypertension. For which diagnostic tests should the nurse prepare this​ patient? Select all that apply. a. renal ultrasound This is the correct answer. b. bladder scan c. renal lithotripsy d. renal arteriogram e. intravenous pyelogram

a. renal u/s d. renal arteriogram This is the correct answer. e. intravenous pyelogram This is the correct answer. ​Rationale: In secondary​ hypertension, a renal cause needs to be ruled out. A renal​ ultrasound, arteriogram, or intravenous pyelogram might be prescribed. A bladder scan determines the amount of residual urine in the bladder. Renal lithotripsy is done when renal calculi are diagnosed.

A patient with a deep vein thrombosis​ (DVT) is going to be weaned from intravenous heparin. When should the nurse anticipate that oral warfarin sodium would be​ prescribed? a. four to five days before the heparin is discontinued b. the same day the heparin is discontinued c. the same day as the heparin is started d. the day before the heparin is discontinued

a. 4-5 days before the heparin is d/c ​Rationale: Oral anticoagulation with warfarin may be initiated concurrently with heparin therapy. Overlapping heparin and warfarin therapy for four to five days is important because the full anticoagulant effect of warfarin is​ delayed, and it may actually promote clotting during the first few days of therapy.

A patient with a history of deep venous thrombosis is prescribed dabigatran​ (Pradaxa). What should the nurse instruct the patient about this​ medication? Select all that apply. a. A reversal agent for this medication is not available. b. Limited amounts of alcohol are permitted. c. Laboratory test monitoring is not necessary for this medication. d. Use a straight razor to shave if necessary. e. The cost of this medication is higher than for warfarin.

a. A reversal agent for this medication is not available. This is the correct answer. c. Laboratory test monitoring is not necessary for this medication. This is the correct answer. e. The cost of this medication is higher than for warfarin. This is the correct answer. ​Rationale: Rivaroxaban​ (Xarelto) acts as a selective factor X​ inhibitor, inactivating the cascade of coagulation. It does not require monitoring like warfarin​ does, however, there is no reversal agent available for this drug. The cost is significantly higher for this drug when compared to warfarin. The patient should be instructed to prevent injury and bleeding. A straight razor would be contraindicated. Alcohol should be avoided while taking this medication.

A patient who is being treated for a deep vein thrombosis​ (DVT) complains of chest pain and shortness of breath. What should the nurse do​ first? a. Elevate the head of the bed and begin oxygen therapy. b. Assess the extremity with the thrombosis. c. Assess the pulses on the extremity with the thrombosis. d. Measure the​ patient's blood pressure.

a. Elevate HOB and begin O2 ​Rationale: Immediately report patient complaints of chest pain and shortness of​ breath, anxiety, or a sense of impending doom. Prompt intervention to restore pulmonary blood flow can reduce the risk of significant adverse effects. Initiate oxygen therapy and elevate the head of the bed. The other interventions are not the priority and would delay the initiation of required interventions in this situation.

A patient with a history of recurrent venous micro emboli is scheduled for an insertion of a Greenfield filter. What should the nurse explain to the patient about this​ procedure? Select all that apply. a. The patient may only need local anesthesia for the procedure. b. Mortality from the insertion of the filter is low. c. The filter will need to be replaced every 6 months. d. The filter can be inserted under fluoroscopy. e. The filter traps emboli while maintaining the patency of the vena cava.

a. The patient may only need local anesthesia for the procedure. This is the correct answer. b. Mortality from the insertion of the filter is low. This is the correct answer. d. The filter can be inserted under fluoroscopy. This is the correct answer. e. The filter traps emboli while maintaining the patency of the vena cava. This is the correct answer. ​Rationale: The Greenfield filter is widely used for its ability to trap emboli within its apex while maintaining patency of the vena cava. The filter can be inserted under fluoroscopy with local anesthesia. Mortality associated with the filter is very low. There is no information to support the frequency in which the filter needs to be replaced.

The nurse suspects a patient recovering from an abdominal aortic aneurysm repair is experiencing graft leaking. What findings did the nurse use to make this clinical​ decision? Select all that apply. a. complaint of groin pain b. urine output 45​ mL/hr c. complaint of back discomfort d. abdominal dressing dry and intact e. respiratory rate 16 and regular

a. c/o groin pain c. c/o back discomfort ​Rationale: The nurse should monitor for and report any​ back, or groin pain. The urine output needs to be below 30​ mL/hr before reporting. A dry abdominal dressing and respiratory rate of 16 and regular are expected findings.

The nurse suspects a patient recovering from an abdominal aortic aneurysm repair is experiencing graft leaking. What findings did the nurse use to make this clinical​ decision? Select all that apply. a. complaint of groin pain b. complaint of back discomfort c. abdominal dressing dry and intact d. urine output 45​ mL/hr e. respiratory rate 16 and regular

a. complaint of groin pain This is the correct answer. b. complaint of back discomfort This is the correct answer. ​Rationale: The nurse should monitor for and report any​ back, or groin pain. The urine output needs to be below 30​ mL/hr before reporting. A dry abdominal dressing and respiratory rate of 16 and regular are expected findings

The nurse suspects that a​ patient's hypertension is being influenced by sympathetic nervous system stimulation. Which substances should the nurse identify as contributing to this​ patient's elevated blood​ pressure? Select all that apply. a. epinephrine This is the correct answer. b. adrenomedullin c. antidiuretic hormone d. angiotensin II e. norepinephrine

a. epinephrine c. antidiuretic hormone This is the correct answer. d. angiotensin II This is the correct answer. e. norepinephrine This is the correct answer. ​Rationale: Epinephrine and​ norepinephrine, and the hormones angiotensin II and antidiuretic hormone are vasoconstrictors that increase the blood pressure. Adrenomedullin is a hormone that decreases blood pressure.

After inspecting a​ patient's left lower​ leg, the nurse leaves the​ patient's room and asks the charge nurse to notify the​ patient's healthcare provider regarding a possible arterial thrombosis. What did the nurse assess to make this​ decision? Select all that apply. a. foot unresponsive to sensation b. ​+4 edema on the ankle c. skin cold to the touch d. absent pedal pulses e. line of demarcation across the foot

a. foot unresponsive to sensation. c. skin cold to the touch This is the correct answer. d. absent pedal pulses This is the correct answer. e. line of demarcation across the foot Rationale: Manifestations of arterial thrombosis include absent distal​ pulses, tissue that is cool or cold to the​ touch, paralysis of the affected​ extremity, and a line of demarcation between normal and ischemic tissue. Edema is not a manifestation of arterial thrombosis

After inspecting a​ patient's left lower​ leg, the nurse leaves the​ patient's room and asks the charge nurse to notify the​ patient's healthcare provider regarding a possible arterial thrombosis. What did the nurse assess to make this​ decision? Select all that apply. a. line of demarcation across the foot b. ​+4 edema on the ankle c. absent pedal pulses d. skin cold to the touch e. foot unresponsive to sensation

a. line of demarcation across the foot c. absent pedal pulses This is the correct answer. d. skin cold to the touch This is the correct answer. e. foot unresponsive to sensation This is the correct answer. ​Rationale: Manifestations of arterial thrombosis include absent distal​ pulses, tissue that is cool or cold to the​ touch, paralysis of the affected​ extremity, and a line of demarcation between normal and ischemic tissue. Edema is not a manifestation of arterial thrombosis.

A patient is diagnosed with an aortic dissection. Which medications should the nurse expect to be prescribed for this​ patient? Select all that apply. a. nitroprusside​ (Nipride) b. verapamil​ (Isoptin) c. diltiazem​ (Cardizem) d. hydralazine​ (Apresoline) e. esmolol​ (Brevibloc)

a. nitroprusside​ (Nipride) This is the correct answer. b. verapamil​ (Isoptin) This is the correct answer. c. diltiazem​ (Cardizem) This is the correct answer. e. esmolol​ (Brevibloc) This is the correct answer. ​Rationale: Patients with aortic dissection are initially treated with intravenous​ beta-blockers such as esmolol​ (Brevibloc) to reduce the heart rate to about 60 bpm. Sodium nitroprusside​ (Nipride) infusion is started concurrently to reduce the systolic pressure to 120 mmHg or less. Calcium channel blockers such as verapamil​ (Isoptin) or diltiazem​ (Cardizem) also may be used. Direct vasodilators such as hydralazine​ (Apresoline) are avoided because they may actually worsen the dissection.

A patient is demonstrating signs of thrombophlebitis. With this​ disorder, the nurse realizes that three mechanisms​ occur, which​ include: Select all that apply. a. stasis of blood flow. b. elevated systemic blood pressure. c. vessel damage. d. blood hypercoagulation. e. pooling of blood in the vessel.

a. stasis of blood flow c. vessel damage d. blood hypercoagulation ​Rationale: Three pathologic​ factors, called​ Virchow's triad, are associated with​ thrombophlebitis: stasis of​ blood, vessel​ damage, and increased blood coagulability. Blood does not pool in the​ vessel; it is restricted. Systemic blood pressure elevation is not a mechanism of this problem.

While conducting an​ assessment, the nurse suspects that a patient is experiencing a hypertensive crisis. What did the nurse assess to make this clinical​ decision? Select all that apply. a. systolic blood pressure 198 mmHg b. complaints of a severe headache c. onset of projectile vomiting d. acute onset of confusion. e. diastolic blood pressure 148 mmHg

a. systolic blood pressure 198 mmHg This is the correct answer. b. complaints of a severe headache This is the correct answer. d. acute onset of confusion This is the correct answer. e. diastolic blood pressure 148 mmHg This is the correct answer. ​Rationale: Manifestations of hypertensive crisis include​ confusion, headache, diastolic blood pressure greater than 120​ mmHg, and systolic blood pressure greater than 180 mmHg. Projectile vomiting is not a manifestation of hypertensive crisis.

While conducting an​ assessment, the nurse suspects that a patient is experiencing a hypertensive crisis. What did the nurse assess to make this clinical​ decision? Select all that apply. a. systolic blood pressure 198 mmHg b. onset of projectile vomiting c. acute onset of confusion. d. diastolic blood pressure 148 mmHg e. complaints of a severe headache

a. systolic blood pressure 198 mmHg This is the correct answer. c. acute onset of confusion This is the correct answer. d. diastolic blood pressure 148 mmHg This is the correct answer. Rationale: Manifestations of hypertensive crisis include​ confusion, headache, diastolic blood pressure greater than 120​ mmHg, and systolic blood pressure greater than 180 mmHg. Projectile vomiting is not a manifestation of hypertensive crisis.

A patient is diagnosed with a disorder in which deoxygenated blood is having difficulty returning to the heart and lungs for reoxygenation. In which part of the peripheral vascular system is the origin of this​ patient's disorder? a. venules b. arteries c. capillaries d. arterioles

a. venules ​Rationale: In the capillary​ beds, oxygen and nutrients are exchanged for metabolic​ wastes, and deoxygenated blood begins its journey back to the heart through​ venules, the smallest vessels of the venous network. The venous network is where the problem with blood returning to the heart resides. Arteries and arterioles are vessels within the arterial​ network, not the venous network.

The nurse is teaching a community education class on hypertension and risk factors for this disorder. What is the primary risk factor leading to the higher incidence of hypertension in older​ adults? a. ​age-related increase in the systolic blood pressure b. being a black adult c. having a family history of hypertension d. being a white male ​Rationale: An​ age-related increase in the systolic blood pressure is the primary factor leading to the high incidence of hypertension in older adults. Systolic blood pressure continues to rise with​ aging, unlike the diastolic blood​ pressure, which tends to rise until age 50 and then levels off. The other options are also risk factors for hypertension in older adults.

a. ​age-related increase in the systolic blood pressure This is the correct answer. ​Rationale: An​ age-related increase in the systolic blood pressure is the primary factor leading to the high incidence of hypertension in older adults. Systolic blood pressure continues to rise with​ aging, unlike the diastolic blood​ pressure, which tends to rise until age 50 and then levels off. The other options are also risk factors for hypertension in older adults.

The nurse calls a patient at home with the laboratory results from his visit of earlier in the day. Based on a review of these​ results, what does the nurse expect the healthcare provider to​ advise? a. Increase the dose of warfarin​ (Coumadin) according to the previous instructions by the physician. b. Maintain the same daily dose of warfarin​ (Coumadin). c. Stop taking the warfarin​ (Coumadin) until the next clinic appointment. d. Maintain the same daily dose of heparin

b. Maintain the same daily dose of warfarin​ (Coumadin). This is the correct answer. Rationale: Prothrombin and INR tests are used to monitor the therapeutic effect of warfarin. Warfarin doses are adjusted to maintain the INR at 2.0dash-​3.0; ​therefore, this patient should be told to maintain the same daily dose of medication. Heparin is monitored by the aPPT test.

The nurse is planning care for a patient who was diagnosed with deep vein thrombosis​ (DVT). What should be included in this plan of​ care? a. Activity as tolerated. b. Encourage the patient to sit out of bed several hours every day. c. Measure and apply elastic antiembolism stockings. d. Assist patient with putting on​ tight-fitting pants.

c. Measure and apply elastic antiembolism stockings. This is the correct answer. ​Rationale: The plan of care for a patient with deep vein thrombosis​ (DVT) includes possible bed​ rest, the duration of which is determined by the extent of leg edema. Elastic antiembolism stockings are frequently ordered to stimulate the​ muscle-pumping mechanism that promotes the return of blood to the heart. Avoid prolonged standing or sitting. Avoid​ tight-fitting garments.

The nurse is instructing a patient with hypertension about lifestyle modifications. What would be appropriate to include in the teaching for this​ patient? Select all that apply. a. Plan a weight lifting regimen. b. Review the DASH diet. c. Eliminate dairy products from the diet. d. Restrict fluid intake. e. Begin a walking​ program, and progress to 30 minutes 5 to 6 days each week.

b. Review the DASH diet. e. Begin a walking​ program, and progress to 30 minutes 5 to 6 days each week. This is the correct answer. ​Rationale: Lifestyle modifications are recommended for all patients whose blood pressure falls within the prehypertension range and everyone with intermittent or sustained hypertension. These modifications include weight​ loss, dietary​ changes, restricted alcohol use and cigarette​ smoking, increased physical​ activity, and stress reduction. Dietary approaches to managing hypertension focus on reducing sodium​ intake, maintaining adequate potassium and calcium​ intakes, and reducing total and saturated fat intake. The DASH diet has proven beneficial effects in lowering blood pressure. Regular exercise reduces blood pressure and contributes to weight​ loss, stress​ reduction, and feelings of overall​ well-being. Previously sedentary patients are encouraged to engage in aerobic exercise for 30 to 45 minutes per day most days of the week. Isometric​ exercise, such as weight​ training, may not be​ appropriate, as it can raise the systolic blood pressure.

The nurse is concerned that a patient recovering from surgery to repair an abdominal aneurysm is developing bowel ischemia. What assessment findings did the nurse use to come to this​ conclusion? Select all that apply. a. hyperactive bowel sounds b. abdominal distention c. onset of abdominal pain d. obvious bloody stool e. diarrhea

b. abdominal distention This is the correct answer. c. onset of abdominal pain This is the correct answer. d. obvious bloody stool This is the correct answer. e. diarrhea This is the correct answer. ​Rationale: Manifestations of bowel ischemia include​ diarrhea, occult or fresh blood in​ stools, abdominal​ distention, and abdominal pain. A change in bowel sounds is not a manifestation of bowel ischemia

A patient comes into the clinic complaining of a new onset of hoarseness. What additional assessment findings should the nurse use to suspect that this patient is experiencing a thoracic​ aneurysm? Select all that apply. a. lumbar back pain b. brassy cough c. distended neck veins d. absent pulses in the wrists e. edema of the face

b. brassy cough This is the correct answer. c. distended neck veins This is the correct answer. e. edema of the face This is the correct answer. rationale: Manifestations of a thoracic aneurysm include a brassy​ cough, facial​ edema, and distended neck veins. Lumbar pain is associated with an abdominal aneurysm. Absent pulses in the wrists are associated with an aortic aneurysm.

A patient comes into the clinic complaining of a new onset of hoarseness. What additional assessment findings should the nurse use to suspect that this patient is experiencing a thoracic​ aneurysm? Select all that apply. a. absent pulses in the wrists b. edema of the face c. distended neck veins d. brassy cough e. lumbar back pain

b. edema of the face This is the correct answer. c. distended neck veins This is the correct answer. d. brassy cough This is the correct answer. Rationale: Manifestations of a thoracic aneurysm include a brassy​ cough, facial​ edema, and distended neck veins. Lumbar pain is associated with an abdominal aneurysm. Absent pulses in the wrists are associated with an aortic aneurysm.

A patient makes an appointment to see the primary healthcare provider because during a routine eye examination the ophthalmologist asked how long the patient had been treated for hypertension. What did the ophthalmologist observe that caused the health problem of hypertension to be​ discussed? Select all that apply. a. astigmatism b. papilledema c. nystagmus d. retinal hemorrhages e. retinal exudates

b. papilledema d. retinal hemorrhages This is the correct answer. e. retinal exudates This is the correct answer. ​Rationale: Manifestations of hypertension result from target organ​ damage, including the eyes. Eye changes include visual​ disturbances, narrowed arterioles in the retina along with​ hemorrhages, exudates, and papilledema or swelling of the optic nerve. Nystagmus and astigmatism are not caused by changes in the eye resulting from hypertension.

The nurse measures a​ patient's blood pressure as​ 144/88 mmHg. What intervention would be most appropriate for this​ patient? a. Inform the physician so antihypertensive medication can be prescribed. b. Remeasure the blood pressure in a few minutes. c. Offer the patient a glass of water. d. Provide​ stress-reduction techniques.

b. remeasure the blood pressure in a few minutes

A patient is diagnosed with an aortic dissection. Which medications should the nurse expect to be prescribed for this​ patient? Select all that apply. a. hydralazine​ (Apresoline) b. sodium nitroprusside​ (Nipride) c. diltiazem​ (Cardizem) d. verapamil​ (Isoptin) e. esmolol​ (Brevibloc)

b. sodium nitroprusside​ (Nipride) This is the correct answer. c. diltiazem​ (Cardizem) This is the correct answer. d. verapamil​ (Isoptin) This is the correct answer. e. esmolol (Brevibloc) ​Rationale: Patients with aortic dissection are initially treated with intravenous​ beta-blockers such as esmolol​ (Brevibloc) to reduce the heart rate to about 60 bpm. Sodium nitroprusside​ (Nipride) infusion is started concurrently to reduce the systolic pressure to 120 mmHg or less. Calcium channel blockers such as verapamil​ (Isoptin) or diltiazem​ (Cardizem) also may be used. Direct vasodilators such as hydralazine​ (Apresoline) are avoided because they may actually worsen the dissection.

A patient with diabetes is beginning treatment for hypertension. What should the nurse explain as being the blood pressure treatment goal for this​ patient? ​a. 135/85 mmHg ​b. 120/80 mmHg ​c. 130/80 mmHg d. ​140/90 mmHg

c. 130/80 ​Rationale: Hypertension management focuses on reducing the blood pressure to less than 140 mmHg systolic and 90 mmHg diastolic. The ultimate goal of hypertension management is to reduce cardiovascular and renal morbidity and mortality. The risk of cardiovascular complications decreases when the average blood pressure is less than​ 140/90; when the patient also has diabetes or renal​ disease, the treatment goal is a blood pressure less than​ 130/80.

The home care nurse instructs a patient with peripheral atherosclerosis on foot care. Which observations indicate that teaching has been​ effective? Select all that apply. a. The patient walks barefoot in the bedroom. b. The patient uses a razor to cut the toenails. c. The patient inspects feet and legs each day with a mirror. d. The patient applies powder to the feet after a shower. e. The patient washes feet and legs with warm water.

c. The patient inspects feet and legs each day with a mirror. This is the correct answer. d. The patient applies powder to the feet after a shower. This is the correct answer. e. The patient washes feet and legs with warm water. This is the correct answer. ​Rationale: Foot care for the patient with peripheral atherosclerosis includes washing the feet and legs with warm​ water, applying powder to the feet after a​ shower, and inspecting the feet and legs each day with a mirror. A professional foot care provider should trim toenails. The patient should be instructed always to wear shoes and not to go barefoot.

During the abdominal assessment of an elderly​ patient, the nurse palpates a mass in the midabdomen. What should the nurse do​ next? a. Ask the patient to cough. b. Get the physician. c. Auscultate the mass. d .Percuss the mass.

c. auscultate the mass ​Rationale: Further assessment is needed before the physician would be​ contacted, typically first by phone. Most abdominal aneurysms are​ asymptomatic, but a pulsating mass in the​ mid- and upper abdomen and a bruit​ (the sound auscultated over turbulent or restricted blood​ flow) over the mass are found on exam. If an aneurysm were​ suspected, asking the patient to cough and percussing the mass would be inappropriate responses that could increase the pressure on the weakened site.

A patient is seen for increasing edema in his left lower extremity and pain in the limb with ambulation. What should the nurse suspect is occurring in this​ patient? a. arterial occlusion b. varicose veins c. deep vein thrombosis d. superficial vein thrombosis

c. deep vein thrombosis This is the correct answer. Rationale: The manifestations of deep vein thrombosis​ (DVT) are primarily due to the inflammatory process that accompanies the thrombus. Calf pain is the most common​ symptom, and it may be described as tightness or a​ dull, aching pain in the affected​ extremity, particularly upon walking. A DVT is not an arterial or a primary superficial vein problem. Varicose veins are tortuous veins with valve insufficiency.

A patient is demonstrating signs of ineffective peripheral tissue perfusion. What intervention would be appropriate for this​ patient? a. Keep extremities cool. b. Encourage patient to reduce level of exercise. c. Discuss smoking cessation techniques. d. Assist with pillow placement under knees.

c. discuss smoking cessation techniques ​Rationale: Interventions for a patient who is experiencing ineffective peripheral tissue perfusion include instructing the patient to avoid smoking. Nicotine is a potent vasoconstrictor that further impairs arterial blood flow. The patient should be instructed on the benefits of regular​ exercise; the importance of keeping the extremities warm but avoid using electronic heating pads or hot water​ bottles; and avoiding crossing legs or using a pillow under the knees.

A patient is demonstrating a sign of blood pressure stabilization accompanied by a decreased urine output. What should the nurse explain is the​ body's mechanism responsible for this blood pressure​ stabilization? a. intake of dietary fat and protein b. change in body temperature c. renal conservation of sodium and water d. response to chemoreceptors in the aortic arch

c. renal conservation of sodium and water ​Rationale: Blood pressure is influenced by many factors. The kidneys help maintain blood pressure by excreting or conserving sodium and water. When blood pressure​ decreases, the kidneys initiate the renindash-angiotensin mechanism. This stimulates​ vasoconstriction, which results in the release of the hormone aldosterone from the adrenal​ cortex, and increases sodium ion reabsorption and water retention. In​ addition, pituitary release of antidiuretic hormone​ (ADH) promotes renal reabsorption of water. The net result is an increase in blood volume and a consequent increase in cardiac output and blood pressure. With the changes​ described, the kidneys are compensating and causing the changes. The changes are not reflective of intervention influenced by the chemoreceptors in the aortic​ arch, body temperature​ changes, or dietary intake.

A patient makes an appointment to see the primary healthcare provider because during a routine eye examination the ophthalmologist asked how long the patient had been treated for hypertension. What did the ophthalmologist observe that caused the health problem of hypertension to be​ discussed? Select all that apply. a. nystagmus b. astigmatism c. retinal exudates d. retinal hemorrhages e. papilledema

c. retinal exudates This is the correct answer. d. retinal hemorrhages This is the correct answer. e. papilledema this is the correct answer. Rationale: Manifestations of hypertension result from target organ​ damage, including the eyes. Eye changes include visual​ disturbances, narrowed arterioles in the retina along with​ hemorrhages, exudates, and papilledema or swelling of the optic nerve. Nystagmus and astigmatism are not caused by changes in the eye resulting from hypertension.

A​ patient's blood pressure continues to be elevated despite being prescribed an ACE inhibitor for several weeks. What should the nurse do at this​ time? a. Schedule the patient to have the blood pressure checked again in a week. b. Suggest to the physician that another medication be added. c. Realize the patient is anxious because of the diagnosis. d. Ask if the patient is taking the prescribed medication.

d. Ask if the patient is taking the prescribed medication. This is the correct answer. ​Rationale: ​Noncompliance, or failure to follow the identified treatment​ plan, is a continuing risk for any patient with a chronic disease. Prescribed medications may have undesirable​ effects, whereas hypertension itself often has no symptoms or noticeable effects. The nurse should inquire about reasons for noncompliance with the recommended treatment plan by assessing for factors that can contribute to​ noncompliance, such as adverse drug effects. If it is determined that the patient is not taking the prescribed​ medication, the other interventions would not be indicated at this time.

A​ 75-year-old patient is diagnosed with chronic venous insufficiency. What should the nurse instruct this​ patient? a. Keep legs in a dependent position as much as possible. b. Limit ambulation. c. Dangle legs over the side of the bed several times per day. d. Avoid the use of​ knee-high hose or girdles.

d. Avoid the use of knee-high hose or girdles. Rationale: Nursing care for the patient with chronic venous insufficiency includes elevating the legs while resting and during​ sleep; walking as much as​ possible, but avoiding sitting or standing for long periods of​ time; when​ sitting, do not cross legs or allow pressure on the back of the​ knees, such as sitting on the side of the​ bed; do not wear anything that pinches​ legs, such as​ knee-high hose,​ garters, or​ girdles; and wearing elastic hose as prescribed.

A​ 75-year-old patient is diagnosed with chronic venous insufficiency. What should the nurse instruct this​ patient? a. Keep legs in a dependent position as much as possible. b. Dangle legs over the side of the bed several times per day. c. Limit ambulation. d. Avoid the use of​ knee-high hose or girdles.

d. Avoid the use of​ knee-high hose or girdles. This is the correct answer. ​Rationale: Nursing care for the patient with chronic venous insufficiency includes elevating the legs while resting and during​ sleep; walking as much as​ possible, but avoiding sitting or standing for long periods of​ time; when​ sitting, do not cross legs or allow pressure on the back of the​ knees, such as sitting on the side of the​ bed; do not wear anything that pinches​ legs, such as​ knee-high hose,​ garters, or​ girdles; and wearing elastic hose as prescribed.

A patient is being discharged on​ long-term oral anticoagulant therapy for arterial thrombus formation in the lower extremity. What should be included in this​ patient's discharge​ instructions? a. Pain in the limb is a sign of healing. b. Take two doses of the prescribed anticoagulant if a dose is missed one day. c. Slight bleeding from the nose is expected. d. Contact the​ physician's office for​ follow-up laboratory studies.

d. Contact the​ physician's office for​ follow-up laboratory studies. This is the correct answer. ​Rationale: When preparing the patient and family for home or​ community-based care related to an acute arterial​ occlusion, the patient should be instructed to​ follow-up with laboratory testing and appointments. Nasal bleeding is not expected. Pain in the limb could indicate another clot has formed. Anticoagulant medications should never be​ "doubled" even in the case of a missed dose. The patient would be encouraged to notify the physician if a dose is missed.

A patient is diagnosed with thromboangiitis obliterans. What would be appropriate teaching for this​ patient? a. Nothing can help manage this disorder. b. Medications are the only cure. c. Surgical procedures can be performed to cure this disorder. d. Management depends upon the​ patient's willingness to stop smoking.

d. Management depends upon the​ patient's willingness to stop smoking. This is the correct answer. ​Rationale: The prognosis for thromboangiitis obliterans depends significantly on the​ patient's ability and willingness to stop smoking. With smoking cessation and good foot​ care, the prognosis for saving the extremities is​ good, even though no cure is available.

An older patient is prescribed elastic graduated compression stockings. What should the nurse instruct the patient about these​ stockings? a. Wear the stockings primarily while sleeping. b. Wear the stockings​ continuously, except when showering. c. Expect areas of skin breakdown under the stockings. d. Remove the stockings once per day and while sleeping.

d. Remove the stockings once per day and while sleeping. This is the correct answer. ​Rationale: Elastic compression stockings compress the​ veins, promoting venous return from the lower extremities. Because elastic stockings inhibit blood flow through small superficial​ vessels, they should be removed at least once each day for at least 30 minutes. Skin breakdown is not anticipated with wearing the stockings and would need to be reported to the physician. They do not need to be removed to sleep.

The nurse is teaching a community education class on hypertension and risk factors for this disorder. What is the primary risk factor leading to the higher incidence of hypertension in older​ adults? a. being a black adult b. having a family history of hypertension c. being a white male ​d. age-related increase in the systolic blood pressure

d. age-related increase in the systolic blood pressure. Rationale: An​ age-related increase in the systolic blood pressure is the primary factor leading to the high incidence of hypertension in older adults. Systolic blood pressure continues to rise with​ aging, unlike the diastolic blood​ pressure, which tends to rise until age 50 and then levels off. The other options are also risk factors for hypertension in older adults.

A patient with some blood loss is maintaining a blood pressure of​ 100/60 mmHg. The nurse interprets this to mean that the​ patient's blood pressure is being maintained through the help of which​ structure? a. veins b. capillaries c. venules d. arterioles

d. arterioles This is the correct answer. ​Rationale: The smaller arterioles are less elastic than arteries but contain more smooth​ muscle, which promotes their constriction​ (narrowing) and dilation​ (widening). In​ fact, arterioles exert the major control over arterial blood pressure. With blood​ loss, the arterioles would constrict as a compensation mechanism to increase blood pressure. This would not happen at the capillary level and is possible in the arterial​ system, not the venous system.

A patient with some blood loss is maintaining a blood pressure of​ 100/60 mmHg. The nurse interprets this to mean that the​ patient's blood pressure is being maintained through the help of which​ structure? a. veins b. venules c. capillaries d. arterioles

d. arterioles This is the correct answer. Rationale: The smaller arterioles are less elastic than arteries but contain more smooth​ muscle, which promotes their constriction​ (narrowing) and dilation​ (widening). In​ fact, arterioles exert the major control over arterial blood pressure. With blood​ loss, the arterioles would constrict as a compensation mechanism to increase blood pressure. This would not happen at the capillary level and is possible in the arterial​ system, not the venous system.

A patient is having segmental pressure measurements conducted to help diagnose peripheral vascular disease. What finding would indicate the presence of this​ disorder? a. thigh pressure higher than the arm b. no difference between the arm or leg c. calf pressure higher than the arm d. calf pressure lower than the arm

d. calf pressure lower than the arm This is the correct answer. ​Rationale: Noninvasive studies often are sufficient to diagnose peripheral vascular disease. Segmental pressure measurements use sphygmomanometer cuffs and a Doppler device to compare blood pressures between the upper and lower extremities and within different segments of the affected extremity. In peripheral vascular disease​ (PVD), the blood pressure may be lower in the legs than in the arms.

The nurse suspects that a patient is experiencing the effects of peripheral atherosclerosis. What did the nurse most likely assess in this​ patient? a. rubor with extremity elevation b. peripheral pulses present bilaterally c. normal hair distribution bilaterally over lower extremities d. complaints of leg pain upon rest

d. complaints of leg pain upon rest This is the correct answer. ​Rationale: Manifestations of peripheral atherosclerosis include intermittent​ claudication; pain at​ rest; paresthesias; diminished or absent peripheral​ pulses; pallor with extremity​ elevation; rubor with extremities in dependent​ position; thin,​ shiny, hairless​ skin; thickened​ toenails; and areas of skin discoloration or skin breakdown.

The nurse completes an assessment with a patient and begins planning care for a venous leg ulcer. What manifestations did the nurse use to make this clinical​ decision? Select all that apply. a. Pulses in the foot are decreased. b. The ulcer is superficial and pink. This is the correct answer. c. The patient rates pain as 8 on a scale from 0 to 10. d. There is an ulcer located on the toe. e. Skin over the leg is discolored brown.

e. Skin over the leg is discolored brown. This is the correct answer. ​Rationale: Manifestations of a venous ulcer include superficial wound that is pink and brown skin discoloration. Arterial ulcers are located on the toe. Pulses are decreased with an arterial ulcer. Severe pain is associated with an arterial ulcer.

A patient with hypertension is prescribed the​ alpha-adrenergic blocker doxazosin​ (Cardura). What should the nurse instruct the patient about this​ medication? Select all that apply. Restrict the intake of all alcoholic beverages and items containing caffeine. Avoid engaging in hazardous activity for 12 to 24 hours after the first dose. This is the correct answer. Notify the primary healthcare provider if nasal congestion develops. This is the correct answer. Change positions slowly and sit down if dizziness occurs. This is the correct answer. Take the medication at bedtime. this is the correct answer

​Rationale: Because of the risk of fainting after taking the first dose of this medication the medication should be taken at bedtime. This drug can cause dizziness. The patient should change positions slowly and sit down if dizziness occurs. The primary healthcare provider should be notified if nasal congestion occurs. Because of the risk of​ fainting, the patient should not drive or engage in hazardous activity for 12 to 24 hours after taking the first dose. There is no need to restrict the intake of alcoholic beverages and items containing caffeine while taking this medication.