AORTIC ANEURYSM Flashcards
The nurse is teaching measures to be followed by a patient. Which action indicates effective learning in a patient who is diagnosed with aortic aneurysm? Select all that apply.
1 The patient avoids kale in the diet.
2 The patient stops eating red meat.
3 The patient stops smoking tobacco.
4 The patient avoids eating salted fish.
5 The patient avoids broccoli in the diet.
ANS: 2,3,4
The patient should take steps to maintain normal blood pressure, which include avoiding eating red meat and tobacco. Eating salted fish also can increase blood pressure and should be avoided. Kale and broccoli are contraindicated for someone who is receiving anticoagulant therapy, but not for a patient with aortic aneurysm.
Which instructions should the nurse include in the discharge plan of a patient who has undergone aortic surgery? Select all that apply.
1 Avoid consuming broccoli.
2 Avoid heavy lifting for six weeks.
3 Observe color of the extremities daily.
4 Palpate the peripheral pulses regularly.
5 Avoid taking aspirin-containing medications
ANS: 2,3,4
The patient who has undergone aortic surgery should avoid heavy lifting for six weeks to prevent excessive stress on the stitches that may lead to bleeding. Observing the color of extremities daily helps to assess blood circulation. Palpating peripheral pulses regularly helps to determine the changes in blood circulation. Broccoli consumption is restricted in patients who are receiving anticoagulant therapy. Aspirin-containing medications are contraindicated in the patient who is taking anticoagulant medication.
The nurse assesses an absence of bowel sounds in a patient that had aortic surgery. The patient reports severe abdominal pain. What nursing action is a priority with this patient? 1 Administer metoprolol 2 Prepare the patient for reoperation 3 Prepare the patient for laser therapy 4 Administer sodium nitroprusside
ANS: 2
Bowel infarction may result from restricted blood flow to the bowel due to occlusion of the mesenteric arteries. Therefore, immediate reoperation is necessary to restore the blood flow. Metoprolol is recommended to the patient who has a history of cardiovascular disease. It is administered to the patient before surgery to reduce morbidity and mortality. Laser therapy will not be beneficial to the patient with a bowel infarction. Sodium nitroprusside is administered to the patient after surgery to prevent hypertension.
While caring for a patient with acute aortic dissection, the nurse finds that β-adrenergic blocker is contraindicated. Which other medication may be beneficial to the patient? 1 Diltiazem 2 Morphine 3 Raloxifine 4 Epoetin alfa
ANS: 1
The initial goal in treating aortic dissection is to maintain the heart rate and blood pressure to prevent stress on the aortic wall. β-adrenergic blockers and calcium channel blockers reduce stress on the aortic wall by decreasing systolic blood pressure and myocardial contractility. Calcium channel blockers such as diltiazem should be administered if β-adrenergic blockers are contraindicated. Morphine reduces pain. Raloxifene is used to prevent osteoporosis. Epoetin alfa is used to stimulate erythropoiesis.
The nurse is assessing a patient with patchy mottling of the feet and toes. What complication should the nurse assess for in this patient? 1 Nephrotic syndrome 2 Deep vein thrombosis 3 Peripheral artery disease 4 Abdominal aortic aneurysm
ANS: 4
An abdominal aortic aneurysm may cause embolism in the small blood vessels, causing patchy mottling of the feet and toes, called blue toe syndrome. Nephrotic syndrome may cause hypercoagulability of blood. Deep vein thrombosis may cause thrombus formation in the deep veins. Peripheral artery disease may cause compartment syndrome after surgery.
A patient reports chest pain and is found to be diaphoretic and pale. Which diagnostic test can the nurse assess to rule out cardiac ischemia? 1 Electrocardiogram 2 Echocardiography 3 Computed tomography scan 4 Magnetic resonance imaging
ANS: 1
Electrocardiogram is used to rule out cardiac ischemia. Echocardiography is used to assess the function of the aortic valve. A computed tomography scan is used to determine the presence of thrombus in the aneurysm. Magnetic resonance imaging is used to diagnose and assess the location and severity of aneurysms.
The nurse assesses that a patient with acute ascending aortic dissection has narrow pulse pressure, jugular venous distention, and a diastolic blood pressure of 60 mm Hg. With what does the nurse correlate these findings? 1 Cardiac tamponade 2 Spinal cord ischemia 3 Mesenteric ischemia 4 Advanced-stage cancer
ANS: 1
The patient who has acute ascending aortic dissection is at high risk of cardiac tamponade. Narrow pulse pressure, jugular venous distention, and diastolic blood pressure of 60 mm Hg or hypotension are symptoms of cardiac tamponade. It occurs due to leakage of blood from the dissection into the pericardial sac. Spinal cord ischemia causes weakness and decreased sensation to the lower extremity and may result in paralysis. Mesenteric ischemia causes abdominal pain and altered bowel function. Phlegmasia cerulea dolens occurs due to an advanced stage of cancer.
A patient has undergone aortic dissection repair. During a follow-up visit, the patient reports depression, fatigue, and inability to maintain an erect penis during sex. About what should the nurse educate the patient? 1 Raynaud’s phenomenon 2 Peripheral arterial disease 3 A side effect of antibiotics 4 A side effect of metoprolol
ANS: 4
Metoprolol is recommended after aortic dissection repair to decrease myocardial contractility. It may cause side effects of depression, fatigue, and erectile dysfunction. Blue color of fingers and toes, pallor, rubor, throbbing, and aching pain due to exposure to cold are symptoms of Raynaud’s phenomenon. Decreased ankle-brachial index, decreased Doppler pressures, cool feet, brittle nails, and atherosclerosis are symptoms of peripheral artery disease. Antibiotics change the normal flora of the intestine and decrease the body’s ability to synthesize biotin as a side effect.
The nurse is caring for a patient who has been receiving warfarin and digoxin as treatment for atrial fibrillation. Because the warfarin has been discontinued before surgery, the nurse should diligently assess the patient for which complication early in the postoperative period until the medication is resumed?
1 Decreased cardiac output
2 Increased blood pressure
3 Cerebral or pulmonary emboli
4 Excessive bleeding from incision or intravenous (IV) sites
ANS: 3
Warfarin is an anticoagulant that is used to prevent thrombi from forming on the walls of the atria during atrial fibrillation. Once the medication is terminated, thrombi could form again. If one or more thrombi detach from the atrial wall, they could travel as cerebral emboli from the left atrium or pulmonary emboli from the right atrium.
Which statement of the student nurse indicates the need for further teaching about postoperative interventions to be followed for a patient who has undergone an aortic aneurysm surgery?
1 “I should administer sodium nitroprusside to the patient.”
2 “I should assess the patient’s body temperature regularly.”
3 “I should administer a broad-spectrum antibiotic to the patient.”
4”I should always keep an indwelling urinary catheter in the patient.”
ANS: 4
The early removal of an indwelling urinary catheter reduces the risk of a urinary tract infection. Sodium nitroprusside reduces high blood pressure and prevents rupture of the sutures. The nurse should assess the patient’s body temperature regularly. Administering broad-spectrum antibiotics to the patient helps prevent risk of infection.
The nurse is caring for a group of patients. Which patient is at greatest risk for developing acute kidney injury?
1 A patient who underwent abdominal aortic aneurysm repair
2 A patient who is receiving long-term treatment with heparin
3 A patient who is receiving nadroparin therapy as well as aspirin
4. A patient who is receiving anticoagulant therapy and eating broccoli frequently
ANS: 1
The patient who has undergone abdominal aortic aneurysm repair is at a higher risk of acute kidney injury. The patient who is receiving long-term treatment of heparin is at a high risk of developing osteoporosis. The interaction between nadroparin and aspirin causes a high risk of bleeding. The patient who is receiving anticoagulant therapy and consuming vitamin K-rich foods, such as broccoli, has an increased risk of bleeding.
A patient is diagnosed with an abdominal aortic aneurysm. The patient undergoes minimally invasive aneurysm repair with an endovascular graft and returns to the room on the unit after the procedure. Which is the priority action for the nurse at this time?
1 Assess the groin area bilaterally.
2 Measure the abdominal girth.
3 Determine when the patient last urinated.
4 Ask the patient to rate pain on a 0 to 10 scale.
ANS: 1
The endovascular graft is placed through the femoral arteries to the area of the aneurysm to prevent further expansion. The nurse first should inspect the groin areas, the femoral artery sites, for bleeding and hematoma. Measuring the abdominal girth, determining when the patient last urinated, and pain assessment are secondary in importance.
Which interventions should the nurse implement before surgery for a patient who is scheduled for aortic dissection repair? Select all that apply.
1 Administer sedation to the patient.
2 Administer dabigatran to the patient.
3 Observe changes in the peripheral pulses.
4 Place the patient in semi-Fowler’s position.
5 Place the patient’s bed in the reverse Trendelenburg position.
ANS: 1,3,4
The nurse should administer sedation to the patient before aortic dissection repair because it prevents extension of the dissection and helps in managing pain. Changes in the peripheral pulses indicate changes in the blood pressure and should be monitored. Placing the patient in semi-Fowler’s position helps maintain vital organ perfusion and ensures normal heart rate and systolic blood pressure. Dabigatran is an oral direct thrombin inhibitor that is used to prevent venous thromboembolism after elective joint replacement. The nurse should place the patient’s bed in the reverse Trendelenburg position if the patient has critical limb ischemia to reduce edema of lower extremities.
Which finding causes the nurse to suspect a risk for graft thrombosis in a patient who has undergone an endovascular graft procedure? 1 Diaphoresis 2 Periumbilical pain 3 Prolonged low blood pressure 4 Elevated white blood cell count
ANS: 3
Adequate blood pressure is important for maintaining graft patency. Prolonged low blood pressure hampers the blood circulation and may increase the risk of graft thrombosis. Diaphoresis and periumbilical pain are symptoms of aneurysm rupture. An elevated white blood cell count indicates infection.
The nurse is preparing a patient for aortic surgery. Which medication does the nurse administer in the preoperative phase? 1 Laxatives 2 Analgesics 3 Antihypertensives 4Intravenous antibiotic
ANS: 4
The nurse should administer an intravenous antibiotic to the patient just before an aortic surgery to prevent the risk of infection. Laxatives should be administered to the patient a day before surgery for clear bowel movement. Analgesics may be given postoperatively. Antihypertensives such as nifedipine are used to reduce the severity of vasospastic attack.
