Deck 38: Nursing Management: Vascular Disorders

Question 1

The nurse has identified the collaborative problem of potential complication: pulmonary embolism for a patient with left-calf DVT. Which nursing action is appropriate to include in the plan of care?

A) Maintain bed rest as ordered.
B) Administer oxygen to keep O₂ saturation >90%.
C) Apply compression gradient stockings.
D) Remind the patient to dorsiflex the feet and rotate the ankles.

Answer 1

Maintain bed rest as ordered.

Question 2

A patient with a DVT is started on IV heparin and oral warfarin (Coumadin). The patient asks the nurse why two medications are necessary. The nurse's best response to the patient is,

A) "Heparin will start to dissolve the clot, and Coumadin will prevent any more clots from occurring."
B) "Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant."
C) "The heparin will work immediately, but the Coumadin takes several days to have an effect on coagulation."
D) "Administration of two anticoagulants reduces the risk for recurrent deep vein thrombosis."

Answer 2

"The heparin will work immediately, but the Coumadin takes several days to have an effect on coagulation."

Question 3

The nurse identifies the nursing diagnosis of ineffective peripheral perfusion related to decreased arterial blood flow for a patient with chronic PAD. In evaluating the patient outcomes following patient teaching, the nurse determines a need for further instruction when the patient says,

A) "I will have to buy some loose clothing that does not bind across my legs or waist."
B) "I will change my position every hour and avoid long periods of sitting with my legs down."
C) "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet."
D) "I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily."

Answer 3

"I will use a heating pad on my feet at night to increase the circulation and warmth in my feet."

Question 4

When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, the information that is most significant when the nurse is assessing for the return of peristalsis is

A) absence of abdominal distention.
B) passing of flatus with ambulation.
C) dark brown nasogastric (NG) tube drainage.
D) moderate abdominal tenderness.

Question 5

The nurse identifies a nursing diagnosis of risk for altered peripheral tissue perfusion related to bypass graft thrombosis for a patient following an abdominal aneurysm repair. An appropriate intervention to prevent this problem in the immediate postoperative period is to

A) use a cooling blanket to maintain the patient's temperature within a normal range to prevent hypercoagulability.
B) place the patient in Trendelenburg position to reduce pressure at the suture line and prevent leaking of blood at the site.
C) administer IV fluids at a rate to keep the arterial BP within a normal range.
D) perform passive range-of-motion (ROM) exercises to the legs hourly to promote venous return.

Question 6

A 72-year-old patient is hospitalized for an aortic dissection of the abdominal aorta that stabilizes with treatment. The nurse develops a teaching plan for the patient's discharge that includes information about

A) gradually increasing exercise to improve cardiac function and BP control.
B) appropriate use of nonsteroidal antiinflammatory agents (NSAIDs) to control any abdominal pain.
C) holding prescribed b-blockers if dizziness or weakness occur to avoid injury.
D) the use of antihypertensive medications to lower the risk of further dissection or bleeding.

Question 7

Several hours following a surgical repair of an abdominal aortic aneurysm, the patient develops left flank pain and a urinary output of 20 ml/hr for 2 hours. The nurse notifies the health care provider and anticipates orders for a(n)

A) additional antibiotic.
B) increase in IV rate.
C) complete blood count.
D) blood urea nitrogen (BUN) and creatinine.

Question 8

A patient who has had a femoral-popliteal bypass graft to the right leg is being cared for on the surgical unit. Which action by an LPN/LVN caring for the patient requires the RN to intervene?

A) The LPN/LVN administers the ordered aspirin 160 mg after breakfast.
B) The LPN/LVN has the patient sit in a bedside chair for 90 minutes.
C) The LPN/LVN assists the patient to ambulate 40 feet in the hallway.
D) The LPN/LVN places the patient in a Fowler's position for meals.

Question 9

A 36-year-old patient who has a history of thromboangiitis obliterans (Buerger's disease) is admitted to the hospital with a gangrenous lesion of the right small toe. When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient?

A) Cessation of smoking
B) Maintenance of appropriate weight
C) Control of serum lipid levels
D) Demonstration of meticulous foot care

Question 10

A patient with a history of a 4-cm abdominal aortic aneurysm is admitted to the emergency department with severe back pain and bilateral flank ecchymoses. The vital signs are blood pressure (BP) 90/58, pulse 138, and respirations 34. The nurse plans interventions for the patient based on the expectation that treatment will include

A) immediate surgery.
B) a STAT angiogram.
C) a paracentesis when vital signs are stabilized with fluid replacement.
D) admission to intensive care for observation and diagnostic testing.

Question 11

A patient admitted to the hospital with DVT has health care provider's orders for bed rest with the feet elevated. The best method for the nurse to use in elevating the patient's feet is to

A) place two pillows under the calf of the affected leg.
B) place the patient in the Trendelenburg position.
C) elevate the bed at the knee and put pillows under the feet.
D) put one pillow under the thighs and two pillows under the lower legs.

Question 12

The health care provider orders a continuous IV heparin infusion for a patient with swelling and pain of the upper leg caused by a DVT. While the patient is receiving the heparin infusion, the nurse should

A) avoid any IM medications to prevent localized bleeding.
B) notify the health care provider if the partial thromboplastin time (PTT) value is greater than 50 seconds.
C) have vitamin K available in case reversal of the heparin is needed.
D) monitor posterior tibial and dorsalis pedis pulses with the Doppler.

Question 13

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective?

A) The patient places the hands in hot water when they turn pale.
B) The patient exercises indoors during the winter months.
C) The patient takes pseudoephedrine (Sudafed) for cold symptoms.
D) The patient avoids the use of aspirin and the NSAIDs.

Question 14

A nursing action that is indicated for the collaborative problem of potential complication: cardiac dysrhythmia in a patient who has had a repair of a descending thoracic aortic aneurysm is to

A) assess level of consciousness and orientation hourly.
B) titrate oxygen to keep O₂ saturation greater than 90%.
C) turn the patient every 1 to 2 hours while on bed rest.
D) monitor hourly fluid intake and urine output levels.

Question 15

After repair of an abdominal aortic aneurysm, the nurse notes that the patient does not have popliteal, posterior tibial, or dorsalis pedis pulses. The legs are cool and mottled. Which action is appropriate for the nurse to take first?

A) Review the preoperative assessment form for data about the pulses.
B) Notify the surgeon and anesthesiologist.
C) Document that the pulses are absent and recheck in 30 minutes.
D) Elevate the lower extremities on pillows.

Question 16

The nurse performing an assessment with a patient who has chronic peripheral arterial disease (PAD) of the legs would expect to find

A) swollen, dry, scaly ankles.
B) a positive Homans' sign.
C) prolonged capillary refill.
D) a draining ulcer on the heel.

Question 17

A patient recovering on a general surgical unit from an aortic valve replacement 1 week ago develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. The nurse should notify the health care provider and

A) elevate the left leg on a pillow.
B) apply an elastic wrap to the leg.
C) keep the patient in bed in the supine position.
D) assist the patient in gently exercising the leg.

Question 18

A 69-year old patient is admitted to the hospital for elective repair of an abdominal aortic aneurysm. The history includes hypertension for 25 years, hyperlipidemia for 15 years, and smoking for 50 years. The patient asks the nurse what caused the aneurysm. The nurse's best response includes the information that

A) congenital weakness of arterial walls eventually results in an aneurysm.
B) atherosclerotic plaques damage the artery and may lead to aneurysms.
C) chronic infections of blood vessel walls may have contributed to the aneurysm.
D) uncontrolled hypertension, hyperlipidemia, and smoking caused the aneurysm.

Question 19

During an assessment of a 63-year-old patient at the clinic, the patient says, "I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though." The nurse should

A) ask about any skin color changes that occur in response to cold.
B) check for the presence of tortuous veins bilaterally on the legs.
C) assess for unilateral swelling, redness, and tenderness of either leg.
D) attempt to palpate the dorsalis pedis and posterial tibial pulses.

Question 20

A patient has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When obtaining a nursing history from the patient, the nurse will ask the patient about

A) abdominal tenderness.
B) difficulty swallowing.
C) changes in bowel habits.
D) dizziness or weakness.

Question 21

In planning care for a patient with a venous stasis ulcer on the right lower leg, the nurse understands that the most important intervention in promoting healing of the ulcer is

A) adequate dietary intake of proteins and vitamins.
B) prevention of infection with prophylactic antibiotics.
C) application of external compression to the lower leg.
D) keeping the ulcer moist with hydrocolloid dressings.

Question 22

A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of these statements by the patient is most consistent with the diagnosis?

A) "I have burning leg pains after I walk three blocks."
B) "I wake up during the night because my legs hurt."
C) "I can't get my shoes on at the end of the day."
D) "I can never seem to get my feet warm enough."

Question 23

A 42-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Before discharging the patient, the nurse teaches the patient that

A) exercises such as walking or jogging cause recurrence of varicosities.
B) sitting at the work counter, rather than standing, is recommended.
C) taking one aspirin daily will help prevent clotting around venous valves.
D) compression stockings should be applied before getting out of bed.

Question 24

A patient with PAD has a new prescription for clopidogrel (Plavix). Which information should the nurse include when teaching the patient about this medication?

A) "Call if you notice that your stools are black or have blood in them."
B) "Take the Plavix on an empty stomach as soon as you get up."
C) "Change position slowly to avoid dizziness while you are taking Plavix."
D) "You should never use aspirin while you are taking the Plavix."

Question 25

Which of these nursing actions in the care plan for a patient who had a repair of an abdominal aortic aneurysm 5 days previously is most appropriate for the nurse to delegate to an experienced nursing assistant?

A) Teach the patient the signs of possible wound infection.
B) Monitor the quality and presence of the pedal pulses.
C) Assist the patient in using a pillow to splint while coughing.
D) Check the lower extremity strength and movement.

Question 26

The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for DVT. The nurse determines that additional teaching is needed when the patient says,

A) "I should wear a Medic Alert bracelet to indicate I am on anticoagulant therapy."
B) "I should change my diet to include more green, leafy vegetables."
C) "I will check with my health care provider before I begin or stop any medication."
D) "I will need to have blood tests routinely to monitor the effects of the Coumadin."

Question 27

When assessing a patient with possible PAD, the nurse obtains a brachial BP of 140/80 and an ankle pressure of 110/70. The nurse calculates the patient's ankle-brachial index (ABI) as ______.
Correct

Question 28

When developing a teaching plan for a patient newly diagnosed with PAD, which information should the nurse include?

A) "Try to keep your legs elevated whenever you are sitting."
B) "Exercise only if you do not experience pain."
C) "It is important to try to stop smoking."
D) "Put on support hose early in the day before swelling occurs."

Question 29

While working in the outpatient clinic, the nurse notes that the chart states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information?

A) "My fingers hurt when I go outside in cold weather."
B) "Sometimes I get tired when I climb a lot of stairs."
C) "When I stand too long, my feet start to swell up."
D) "My legs cramp whenever I walk more than a block."

Question 30

Which statement by a patient who is being discharged 5 days after an abdominal aortic aneurysm repair and graft indicates that the discharge teaching has been effective?

A) "I will call the doctor if my temperature is higher than 101° F."
B) "I will tell my dentist about this surgery the next time I have an appointment."
C) "I should not need to take anything but acetaminophen (Tylenol) for my pain."
D) "I am eager to get home so that I can pick up my 6-year-old granddaughter."

Question 31

A patient who is seen in the clinic tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynaud's phenomenon. The nurse will anticipate teaching the patient about tests for

A) coronary artery disease.
B) familial hyperlipidemia.
C) high BP.
D) immune disorders.