Lewis Ch-40: Vascular Disorders Flashcards
(30 cards)
The nurse is discussing the risk factor modification for a client who has a 4-cm abdominal aortic aneurysm. The nurse should focus client teaching on which of the following risk factors?
a. Male gender
b. Marfan syndrome
c. Abdominal trauma history
d. Uncontrolled hypertension
d. Uncontrolled hypertension
An abdominal aortic aneurysm is basically your aorta (the big artery running from your heart through your belly) slowly giving up and ballooning out. At 4 cm, it’s not emergency surgery territory yet—but it’s definitely a “keep an eye on this unless you want your insides to become outsides” kind of deal.
Now about risk factors. Some of these you can’t change—like:
• a. Male gender: Sorry about your chromosomes, bro.
• b. Marfan syndrome: That’s a genetic thing. You either got it or you don’t.
• c. Abdominal trauma history: Can’t go back in time to dodge that ladder fall.
But d. Uncontrolled hypertension? Ding ding ding. That’s the one you can fix. High blood pressure means more force hitting the walls of that aneurysm like it’s trying to win a demolition derby. So yeah, blood pressure control is the main character in your little AAA survival story.
The nurse is obtaining a health history from a client who has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. Which of the following symptoms should the nurse expect to assess in the client?
a. Back or lumbar pain
b. Difficulty swallowing
c. Abdominal tenderness
d. Changes in bowel habits
b. Difficulty swallowing
The thoracic aorta is sitting right next door to the esophagus. As that aneurysm expands, it compresses the esophagus, which is a soft, squishy tube that just wants to do its job—namely, move food from your mouth to your stomach without being rudely squashed. But no, the aneurysm says: “This is my space now.”
Result? Dysphagia—difficulty swallowing—because it’s hard to push food past a pulsating meat balloon that’s pressing on your food chute.
Several hours after an open surgical repair of an abdominal aortics aneurysm, the client develops a urinary output of 20 mL/hour for 2 hours. Which of the following prescriptions should the nurse anticipate?
a. An additional antibiotic
b. WBC count
c. Decrease in IV infusion rate
d. Blood urea nitrogen level
d. Blood urea nitrogen level
BUN and creatinine are important labs that help evaluate renal function. An elevated BUN may indicate:
• Reduced renal perfusion
• Dehydration
• Renal failure
A client in the outpatient clinic has a new diagnosis of peripheral artery disease. Which of the following medication categories should the nurse plan to include when providing client teaching about PAD management?
a. Statins
b. Vitamins
c. Thrombolytics
d. Anticoagulants
a. Statins
Peripheral Artery Disease (PAD) = your arteries are basically throwing tantrums by narrowing and reducing blood flow to the limbs. Usually the legs. So you end up with leg pain when walking (called claudication, which sounds fancy but means “your legs are mad at you”).
Now—statins are the golden ticket here because:
• They lower cholesterol, especially that rascal LDL (the bad one).
• They help slow the progression of atherosclerosis (aka arteries turning into clogged pipes).
• They even have anti-inflammatory effects on vessels.
The nurse is caring for a client with chronic artrial fibrillation who develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. Which of the following actions should the nurse implement first?
a. Elevate the left leg on a pillow
b. Apply an elastic wrap to the leg.
c. Assist the client in gently exercising the leg
d. Notify the health care provider
d. Notify the health care provider
This question is a classic “don’t accidentally kill your patient” scenario. The symptoms described — sudden severe pain, pulselessness, pallor, and coolness — scream acute arterial occlusion, which is a medical emergency, not something you treat with a pillow and good vibes.
So yes, the correct answer is d. Notify the health care provider, because you’re not a vascular surgeon in disguise. That leg is about to stage a dramatic exit unless someone intervenes with an actual plan that involves more than elevating it like it’s having a spa day.
The other options are basically different flavors of Oops, made it worse. Wrapping it, exercising it, or elevating it could all worsen ischemia.
A client at the clinic 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.” Which of the following actions should the nurse implement?
a. Attempt to palpate the dorsalis pedis and posterior tibial pulses.
b. Check for the presence of tortuous veins bilaterally on the legs.
c. Ask about any skin colour changes that occur in response to cold.
d. Assess for unilateral swelling, redness, and tenderness of either leg.
a. Attempt to palpate the dorsalis pedis and posterior tibial pulses.
The client’s symptoms—leg cramps during walking that disappear with rest—are basically Peripheral Artery Disease (PAD) yelling, “Notice me!” in a very dramatic, vascular way. The classic description here is intermittent claudication, which is like angina for your calves.
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Why palpating dorsalis pedis and posterior tibial pulses is the right move:
Those distal pulses are your early warning system for arterial insufficiency. If blood flow is sad and sluggish down there, the pulses will be weak or absent, confirming that the legs are not getting enough oxygen when demand goes up (like, you know, walking).
The nurse is assessing a client who has chronic peripheral artery disease of the legs and an ulcer on the left great toe. Which of the following findings should the nurse expect?
a. A positive Homans’ sign
b. Swollen, dry, scaly ankles
c. Prolonged capillary refill in all the toes
d. A large amount of drainage from the ulcer
c. Prolonged capillary refill in all the toes
The nurse is providing teaching to a client with critical limb ischemia. Which of the following client statements indicate further teaching required?
a. “I will have to buy some loose clothing that does not bind across my legs or waist.”
b. “I will use a heating pad on my feet at night to increase the circulation and warmth in my feet.”
c. “I will walk to the point of pain, rest, and walk again until i develop pain for a half hour daily.”
d. “I will change my position every hour and avoid long periods of sitting with my legs down.”
b. “I will use a heating pad on my feet at night to increase the circulation and warmth in my feet.”
Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease (PAD). It means there’s severely reduced blood flow to the legs or feet — like, “your tissue might die” levels of bad circulation.
Key points:
• Causes: usually advanced atherosclerosis (plaque build-up in arteries).
• Symptoms: constant leg pain even at rest, non-healing wounds, numbness, shiny skin, or even gangrene.
• Big risk: limb loss if not treated.
• Treatment: meds, lifestyle changes, sometimes surgery or amputation.
Now, about that heating pad — it’s a hard no for CLI.
These patients have reduced sensation due to poor circulation, so they can’t feel if the pad gets too hot and burns them without realizing it. Cozy feet, crispy consequences.
The nurse is providing teaching to a client with a newly diagnosed Raynaud’s phenomenon about how to manage the condition. Which of the following behaviours by the client indicates that the teaching has been effective?
a. The client avoids the use of Aspirin and nonsteroidal anti-inflammatory drugs
b. The client exercises indoors during the winter months
c. The client places the hands in hot water when they turn pale
d. The client takes pseudoephedrine for cold symptoms
b. The client exercises indoors during the winter months
This answer’s all about Raynaud’s phenomenon, where the blood vessels in your fingers (and sometimes toes) spasm in response to cold or stress, causing the skin to turn white, then blue, then red. It’s dramatic. Like your fingers are putting on a tiny patriotic light show.
So why is “exercises indoors during the winter months” the best answer?
Because:
• Cold is a trigger for Raynaud’s attacks.
• Staying indoors helps limit exposure to cold temps.
• Exercise helps promote circulation and reduce vasospasms.
The other options?
• Hot water (c) can cause rebound vasoconstriction (aka: “Nice try, now suffer more”).
• Pseudoephedrine (d) is a vasoconstrictor—you’d basically be asking for a flare-up.
• Aspirin (a) isn’t avoided; in fact, it can sometimes help with circulation issues in Raynaud’s.
The nurse notes bruising and discoloration of the right leg of a client that has just arrived in the recovery unit from having vein ligation surgery. Which of the following interventions is priority?
a. Place the client in the trendelenburg position
b. Contact the health care provider
c. Elevate the bed at the knee and put pillows under the feet.
d. elevate the leg 15 degrees to limit edema
d. elevate the leg 15 degrees to limit edema
The health care provider prescribes an infusion of argatroban and daily partial thromboplastin time (PTT) testing for a client with venous thromboembolism (VTE). Which of the following actions should the nurse include in the plan of care?
a. Avoid giving any IM medications to prevent localized bleeding.
b. Discontinue the infusion for PTT values greater than 50 seconds
c. Monitor posterior tibial and dorsalis pedis pulses with the doppler.
d. Have vitamin K available in case reversal of teh argatroban is needed.
a. Avoid giving any IM medications to prevent localized bleeding.
A client with a venous thromboembolism (VTE) is started on enoxaparin and warfarin. The client asks the nurse why two medications are necessary. Which of the following responses by the nurse is accurate?
a. “Administration of two anticoagulants reduces the risk for recurrent venous thrombosis.”
b. “Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from occurring.”
c. “The enoxaparin will work immediately, but the warfarin takes several days to have an effect on coagulation.”
d. “Because of the potential for pulmonary embolism, it is important for you to have more than on anticoagulant.”
c. “The enoxaparin will work immediately, but the warfarin takes several days to have an effect on coagulation.”
The nurse has initiated discharge teaching for a client who is to be maintained on warfarin following hospitalization for venous thromboembolism (VTE). Which of the following client statements indicates that additional teaching is required?
a. “I should reduce the amount of green, leafy vegetables that I eat”
b. “I should wear a Medic Alert bracelet stating that I take warfarin.”
c. “I will need to have blood tests routinely to monitor the effects of the warfarin.”
d. “I will check with my health care provider before i begin or stop any medication.”
a. “I should reduce the amount of green, leafy vegetables that I eat”
The nurse is caring for a client who had a sclerotherapy for treatment of superficial varicose veins and is a service-counter worker. Which of the following information should the nurse include when providing discharge teaching to the client?
a. Sitting at the work counter, rather than standing, is recommended.
b. Compression stockings should be applied before getting out of bed.
c. Exercises such as walking or jogging cause recurrence of varicosities.
d. Taking on Aspirin daily will help prevent clotting around venous valves.
b. Compression stockings should be applied before getting out of bed.
The nurse is providing teaching to a client with chronic venous insufficiency who has a venous ulcer on the right lower leg. Which of the following topics should the nurse include in the teaching plan?
a. Adequate carbohydrate intake
b. Prophylactic antibiotic therapy
c. Application of compression to the leg
d. Methods of keeping the wound area dry
c. Application of compression to the leg
A client is admitted to the hospital with a diagnostic of chronic venous insufficiency. Which of the following client statements is most consistent with this diagnosis?
a. “I cant get my shoes on at the end of the day”
b. “I can never seem to get my feet warm enough”
c. “I wake up during the night because my legs hurt”
d. “I have burning leg pains after i walk three blocks”
a. “I cant get my shoes on at the end of the day”
Which of the following nursing actions should be included in the plan of care for a client who has had endovascular repair of an abdominal aortic aneurysm?
a. Record hourly chest tube drainage
b. Monitor fluid intake and urine output
c. Check the abdominal wound for redness or swelling
d. Tach the reason for a prolonged rehabilitation process.
b. Monitor fluid intake and urine output
Which of the following actions by a nurse who is administering fondaparinux to a client with venous thromboembolism (VTE) indicates that more education about the medication is needed?
a. The nurse avoids rubbing the injection site after giving the medication
b. The nurse injects the medication into the abdominal subcutaneous tissue
c. The nurse fails to assess the partial thromboplastin time (PTT) before administration of the medication.
d. The nurse ejects the air bubble in the syringe before administering the medication.
d. The nurse ejects the air bubble in the syringe before administering the medication.
A client tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynaud’s phenomenon. Based upon this diagnosis, the client should be investigated for which of the following conditions?
a. Hypertension
b. Hyperlipidemia
c. Autoimmune disorders
d. Coronary artery disease
c. Autoimmune disorders
While working in the outpatient clinic, the nurse notes that the medical record states that a client has intermittent claudication. Which of the following client statements is consistent with this information?
a. “When I stand too long, my feet start to sell up.”
b. “sometimes I get tired when I climb a lot of stairs.”
c. “ My fingers hurt when I go outside in cold weather.”
d. “My legs cramp whenever I walk more than a block.”
d. “My legs cramp whenever I walk more than a block.”
The nurse is developing a teaching plan for a client newly diagnosed with perihperal artery disease. Which of the following information should the nurse include?
a. “Exercise only if you do not experience any pain”
b. “It is very important that you stop smoking cigarettes.”
c. “Try to keep your legs elevated whenever you are sitting.”
d. “Put on support hose early in the day before swelling occurs.”
b. “It is very important that you stop smoking cigarettes.”
The nurse is admitting a client to the emergency department with a history of an abdominal aortic aneurysm with severe back pain and absent pedal pulses. Which of the following actions should the nurse take first?
a. Obtain the blood pressure
b. Ask the client about tobacco use
c. Draw blood for ordered laboratory testing.
d. Assess for the presence of an abdominal bruit
a. Obtain the blood pressure
Which of the following clients admitted to the emergency department should the nurse assess first?
a. 62-year-old who has gangrenous ulcers on both feet
b. 50-year-old who is complaining of “tearing” chest pain
c. 45-year-old who is taking anticoagulants and has bloody stools
d. 36-year-old who has right calf tenderness, redness, and swelling.
b. 50-year-old who is complaining of “tearing” chest pain
Immediately after repair of an abdominal aortic aneurysm, a client has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which of the following actions should the nurse take first?
a. Wrap both legs in warm blankets
b. Notify the surgeon and anaesthesiologist
c. Document that the pulses are absent and recheck in 30 minutes
d. Review the preoperative assessment form for data about the pulses.
d. Review the preoperative assessment form for data about the pulses.
