‼️FINAL Aortic Aneurysm & Dissection‼️

Question 1

Which patient symptom is most indicative of an abdominal aortic aneurysm (AAA)?
A. Dyspnea and hoarseness
B. Pulsatile mass in the periumbilical area
C. Jugular venous distention
D. Decreased urinary output

Answer 1

B. Pulsatile mass in the periumbilical area
Rationale: A pulsatile mass slightly to the left of midline is a hallmark sign of AAA. Dyspnea and hoarseness are more common with thoracic aneurysms.

Question 2

Which is the most important modifiable risk factor for developing an aortic aneurysm?
A. Age
B. Hypertension
C. Tobacco use
D. Hyperlipidemia

Answer 2

C. Tobacco use
Rationale: Tobacco use contributes to the breakdown of elastin in the aortic wall, making it the most important modifiable risk factor.

Question 3

What is the priority nursing action for a patient with a newly diagnosed thoracic aortic aneurysm?
A. Start IV fluids
B. Prepare for surgical repair
C. Control blood pressure
D. Administer antiplatelet therapy

Answer 3

C. Control blood pressure
Rationale: Stabilizing BP reduces stress on the aortic wall and lowers the risk of rupture.

Question 3

Which assessment finding indicates possible rupture of an abdominal aortic aneurysm?
A. Bounding pulses
B. Increased bowel sounds
C. Grey Turner’s sign
D. Bradycardia

Answer 3

C. Grey Turner’s sign
Rationale: Flank bruising (Grey Turner’s sign) suggests retroperitoneal bleeding, often associated with a ruptured AAA.

Question 4

Which type of aneurysm involves all layers of the arterial wall?
A. False aneurysm
B. Dissecting aneurysm
C. True aneurysm
D. Pseudoaneurysm

Answer 4

C. True aneurysm
Rationale: A true aneurysm involves dilation of all three layers of the artery wall.

Question 5

What is a common symptom of a thoracic aortic aneurysm?
A. Left lower quadrant abdominal pain
B. Sharp chest pain radiating to the shoulder
C. Hoarseness or difficulty swallowing
D. Leg cramps with activity

Answer 5

C. Hoarseness or difficulty swallowing
Rationale: A thoracic aneurysm can press on the laryngeal nerve or esophagus, causing hoarseness or dysphagia.

Question 6

Which diagnostic test is preferred for assessing a stable abdominal aortic aneurysm?
A. ECG
B. Abdominal ultrasound
C. MRI of the spine
D. Chest x-ray

Answer 6

B. Abdominal ultrasound
Rationale: Ultrasound is noninvasive, cost-effective, and highly reliable for detecting and monitoring AAAs.

Question 7

Which finding should be immediately reported in a post-op AAA repair patient?
A. Urine output of 50 mL/hour
B. Warm, pink extremities
C. Absent dorsalis pedis pulse
D. Incisional pain rated 5/10

Answer 7

C. Absent dorsalis pedis pulse
Rationale: May indicate graft occlusion or embolization—an urgent surgical emergency.

Question 8

What type of aneurysm has a “sac-like” appearance on imaging?
A. Fusiform aneurysm
B. Saccular aneurysm
C. True aneurysm
D. False aneurysm

Answer 8

B. Saccular aneurysm
Rationale: Saccular aneurysms are pouch-like and involve only one side of the arterial wall.

Question 9

Which vital sign goal is prioritized in managing aortic dissection?
A. HR less than 60, SBP 100–110 mmHg
B. HR above 90, DBP above 90 mmHg
C. MAP over 100 mmHg
D. RR less than 10/min

Answer 9

A. HR less than 60, SBP 100–110 mmHg
Rationale: Reducing HR and SBP minimizes stress on the aortic wall and limits dissection progression.

Question 10

Which drug is most commonly used for initial BP control in aortic dissection?
A. Lisinopril
B. Metoprolol
C. Esmolol/labatalol
D. Nifedipine

Answer 10

C. Esmolol
Rationale: Esmolol is a short-acting IV beta-blocker used to quickly lower HR and SBP.

Question 11

Which symptom would suggest cardiac tamponade in aortic dissection?
A. Bradycardia
B. Widened pulse pressure
C. Muffled heart sounds
D. Bounding peripheral pulses

Answer 11

C. Muffled heart sounds
Rationale: Muffled heart sounds are a sign of tamponade, along with hypotension and jugular venous distention.

Question 12

What does a type A aortic dissection involve?
A. Descending thoracic aorta
B. Aortic arch and ascending aorta
C. Abdominal aorta
D. Left subclavian artery

Answer 12

B. Aortic arch and ascending aorta
Rationale: Type A dissections affect the ascending aorta and are surgical emergencies.

Question 13

Which surgical procedure involves a large abdominal incision and graft placement?
A. Endovascular repair
B. Transcatheter stent placement
C. Open aneurysm repair
D. TEVAR

Answer 13

C. Open aneurysm repair
Rationale: Open aneurysm repair (OAR) is a traditional surgery involving a large incision and grafting.

Question 14

What is the main purpose of an endovascular aneurysm repair (EVAR)?
A. Cure the aneurysm
B. Remove the aneurysm
C. Reinforce the aorta and divert blood flow
D. Replace the aortic valve

Answer 14

C. Reinforce the aorta and divert blood flow
Rationale: EVAR involves stent graft placement to prevent aneurysm rupture by redirecting blood flow.

Question 15

Which sign may indicate embolization after AAA surgery?
A. Bounding pedal pulses
B. Warm lower extremities
C. Blue toe syndrome
D. Decreased BP

Answer 15

C. Blue toe syndrome
Rationale: Blue toe syndrome results from plaque embolization causing ischemia despite palpable pulses.

Question 16

Which is a serious complication of EVAR?
A. Bleeding
B. Wound dehiscence
C. Endoleak
D. Atelectasis

Answer 16

C. Endoleak
Rationale: Endoleak is the most common complication, allowing blood to leak into the old aneurysm sac.

Question 17

What is the first nursing action after suspected aortic rupture?
A. Administer oral beta-blockers
B. Prepare for emergency surgery
C. Insert Foley catheter
D. Reassess in 15 minutes

Answer 17

B. Prepare for emergency surgery
Rationale: A ruptured aneurysm requires immediate surgical intervention to prevent death.

Question 18

Which complication of dissection may cause sudden paralysis?
A. Myocardial infarction
B. Renal ischemia
C. Spinal cord ischemia
D. Aortic stenosis

Answer 18

C. Spinal cord ischemia
Rationale: Compromised spinal cord perfusion during dissection may result in lower extremity weakness or paralysis.

Question 19

Why are peripheral pulses checked hourly post-op aortic surgery?
A. Detect infection
B. Assess cardiac output
C. Monitor for graft occlusion
D. Evaluate wound healing

Answer 19

C. Monitor for graft occlusion
Rationale: Diminished or absent pulses may indicate graft occlusion or embolization, requiring immediate attention.

Question 20

Which is a priority nursing diagnosis for a patient with an aortic dissection?
A. Risk for infection
B. Risk for falls
C. Risk for decreased perfusion
D. Deficient fluid volume

Answer 20

C. Risk for decreased perfusion
Rationale: Aortic dissection impairs blood flow to organs and tissues, making decreased perfusion a priority concern.

Question 21

Which intervention helps prevent aortic rupture in a patient with an aneurysm?
A. Encouraging a high-fiber diet
B. Administering antihypertensives as prescribed
C. Applying abdominal binders
D. Restricting protein intake

Answer 21

B. Administering antihypertensives as prescribed
Rationale: Controlling BP is essential to decrease aortic wall stress and prevent rupture.

Question 22

During assessment, which finding most suggests aortic dissection?
A. Pulsatile midline mass
B. Bruits over the femoral artery
C. Sudden, tearing chest or back pain
D. Epigastric fullness after meals

Answer 22

C. Sudden, tearing chest or back pain
Rationale: The hallmark of aortic dissection is sudden, severe, tearing pain in the chest or back.

Question 23

Which finding would require immediate HCP notification in a patient with aortic dissection?
A. Systolic BP 148 mmHg
B. Slightly elevated WBC count
C. Widened mediastinum on chest x-ray
D. BP difference between arms

Answer 23

D. BP difference between arms
Rationale: A difference in BP between arms suggests involvement of subclavian arteries, common in dissections.

Question 24

What is the most important goal in the planning phase for a patient with AAA? A. Promote weight loss B. Restore perfusion and prep for surgical repair C. Increase fluid intake D. Administer antibiotics

Answer 24

B. Restore perfusion and prep for surgical repair Rationale: Planning focuses on stabilizing the patient and preventing rupture by preparing for surgical intervention.

Question 25

What is the expected outcome after EVAR surgery for AAA? A. Elimination of the aneurysm sac B. Shunting of blood flow through the stent graft C. Surgical removal of the aorta D. Correction of valve dysfunction

Answer 25

B. Shunting of blood flow through the stent graft Rationale: EVAR stabilizes the aneurysm by diverting blood flow through a graft, reducing pressure on the aneurysm wall.

Question 26

What is the most appropriate patient education point before aortic surgery? A. Avoid opioid pain medication B. Remain on a full diet C. Expect an NPO order after midnight D. Begin anticoagulation therapy immediately

Answer 26

C. Expect an NPO order after midnight Rationale: Patients undergoing surgery are typically NPO after midnight to reduce aspiration risk.

Question 27

Which lab value is most important to monitor after open aneurysm repair? A. Platelet count B. Serum creatinine C. Hemoglobin A1C D. Troponin I

Answer 27

B. Serum creatinine Rationale: Renal perfusion may be compromised during surgery. Monitoring creatinine helps detect early AKI.

Question 28

Which postoperative intervention supports prevention of graft thrombosis? A. Applying antiembolism stockings B. Elevating the head of bed C. Maintaining adequate BP D. Encouraging early ambulation

Answer 28

C. Maintaining adequate BP Rationale: Ensuring adequate BP supports perfusion through the graft and prevents thrombosis.

Question 29

What instruction should a nurse give a patient going home after aortic repair? A. Resume normal activities immediately B. Avoid heavy lifting for 6 weeks C. Discontinue antihypertensives when feeling better D. Apply ice to the incision daily

Answer 29

B. Avoid heavy lifting for 6 weeks Rationale: Heavy lifting increases intraabdominal pressure and can compromise the surgical site or graft.