Cardiovascular System Flashcards
A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency. Which patient statement is most supportive of the diagnosis?
a. “I can’t get my shoes on at the end of the day.”
b. “I can’t seem to ever get my feet warm enough.”
c. “I have burning leg pains after I walk two blocks.”
d. “I wake up during the night because my legs hurt.”
ANS: A
Because the edema associated with venous insufficiency increases when the patient has been standing, shoes will feel tighter at the end of the day. The other patient statements are characteristic of peripheral artery disease (PAD).
A 73-year-old patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and
coolness in the right leg. The nurse should notify the health care provider and immediately
a. apply a compression stocking to the leg.
b. elevate the leg above the level of the heart.
c. assist the patient in gently exercising the leg.
d. keep the patient in bed in the supine position.
ANS: D
The patient’s history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand for the tissues of the leg
An 80-year-old patient with a history of an abdominal aortic aneurysm arrives at the emergency department
(ED) with severe back pain and absent pedal pulses. Which actions should the nurse take first?
a. Obtain the blood pressure.
b. Obtain blood for laboratory testing.
c. Assess for the presence of an abdominal bruit.
d. Determine any family history of kidney disease.
ANS: A
Because the patient appears to be experiencing aortic dissection, the nurse’s first action should be to determine the hemodynamic status by assessing blood pressure. The other actions also may be done, but they will not provide information that will determine what interventions are needed immediately for this patient
After receiving report, which patient admitted to the emergency department should the nurse
assess first?
a. 67-year-old who has a gangrenous left foot ulcer with a weak pedal pulse
b. 58-year-old who is taking anticoagulants for atrial fibrillation and has black stools
c. 50-year-old who is complaining of sudden “sharp” and “worst ever” upper back pain
d. 39-year-old who has right calf tenderness, redness, and swelling after a long plane ride
ANS: C
The patient’s presentation is consistent with dissecting
thoracic aneurysm, which will require rapid intervention.
The other patients do not need urgent interventions
The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital
with venous thromboembolism. Which action by the nurse to elevate the patient’s feet is best?
a. The patient is placed in the Trendelenburg position.
b. Two pillows are positioned under the affected leg.
c. The bed is elevated at the knee and pillows are placed under the feet.
d. One pillow is placed under the thighs and two pillows are placed under the lower legs.
ANS: D
The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the patient in the Trendelenburg position will lower the head below heart level, which is not indicated for this patient. Placing pillows under the calf or elevating the bed at the knee
may cause blood stasis at the calf level
The nurse is caring for a patient immediately after repair of an abdominal aortic aneurysm. On assessment,
the patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled.
Which action should the nurse take first?
a. Notify the surgeon and anesthesiologist.
b. Wrap both the legs in a warming blanket.
c. Document the findings and recheck in 15 minutes.
d. Compare findings to the preoperative assessment of the pulses.
ANS: A
Lower extremity pulses may be absent for a short time after surgery because of vasospasm and hypothermia.
Decreased or absent pulses together with a cool and mottled extremity may indicate embolization or graft
occlusion. These findings should be reported to the physician immediately because this is an emergency
situation. Because pulses are marked prior to surgery, the nurse would know whether pulses were present
prior to surgery before notifying the health care providers about the absent pulses. Because the patient’s symptoms may indicate graft occlusion or multiple emboli and a possible need to return to surgery, it is not appropriate to wait 15 minutes before taking action. A warming blanket will not improve the circulation to the patient’s legs.
The nurse is caring for a patient with a descending aortic dissection. Which assessment finding is most important to report to the health care provider?
a. Weak pedal pulses
b. Absent bowel sounds
c. Blood pressure 137/88 mm Hg
d. 25 mL urine output over last hour
ANS: C
The blood pressure is typically kept at less than 120 mm Hg systolic to minimize extension of the dissection. The nurse will need to notify the health care provider so that b-blockers or other antihypertensive medications can
be prescribed. The other findings are typical with aortic dissection and should also be reported but do not require immediate action
The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after
having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first?
a. Begin oral intake.
b. Obtain vital signs.
c. Assess pedal pulses.
d. Start discharge teaching.
ANS: B
Bleeding is a possible complication after catheterization of the femoral artery, so the nurse’s first action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions are also appropriate but
can be done after determining that bleeding is not occurring
The nurse performing an assessment with a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe would expect to find
a. dilated superficial veins.
b. swollen, dry, scaly ankles.
c. prolonged capillary refill in all the toes.
d. a serosanguineous drainage from the ulcer.
ANS: C
Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease
The nurse who works in the vascular clinic has several patients with venous insufficiency scheduled today.
Which patient should the nurse assign to an experienced licensed practical/vocational nurse (LPN/LVN)?
a. Patient who has been complaining of increased edema and skin changes in the legs
b. Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg
c. Patient who has a history of venous thromboembolism and is complaining of some dyspnea
d. Patient who needs teaching about the use of elastic compression stockings for venous insufficiency
ANS: B
LPN education and scope of practice includes wound
care. The other patients, which require more complex
assessments or education, should be managed by the RN.
A patient at the clinic says, “I have always taken a walk after dinner, but lately my leg cramps and hurts after
just a few minutes of starting. The pain goes away after I stop walking, though.” The nurse should
a. check for the presence of tortuous veins bilaterally on the legs.
b. ask about any skin color changes that occur in response to cold.
c. assess for unilateral swelling, redness, and tenderness of either leg.
d. assess for the presence of the dorsalis pedis and posterior tibial pulses.
ANS: D
The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynaud’s phenomenon. Tortuous veins on the legs suggest venous
insufficiency. Unilateral leg swelling, redness, and tenderness indicate venous thromboembolism (VTE).
A patient has a 6-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. When
obtaining an admission history from the patient, it will be most important for the nurse to ask about
a. low back pain.
b. trouble swallowing.
c. abdominal tenderness.
d. changes in bowel habits.
ANS: B
Difficulty swallowing may occur with a thoracic aneurysm
because of pressure on the esophagus. The other symptoms will be important to assess for in patients with abdominal aortic aneurysms
A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of
medications will the nurse plan to include when providing patient teaching about PAD management?
a. Statins
b. Antibiotics
c. Thrombolytics
d. Anticoagulants
ANS: A
Current research indicates that statin use by patients with
PAD improves multiple outcomes. There is no research
that supports the use of the other medication categories in PAD.
A patient who is 2 days post-femoral-popliteal bypass graft to the right leg is being cared for on the
vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN) caring for the patient
requires the registered nurse (RN) to intervene?
a. The LPN/LVN has the patient sit in a chair for 90 minutes.
b. The LPN/LVN assists the patient to walk 40 feet in the hallway.
c. The LPN/LVN gives the ordered aspirin 160 mg after breakfast.
d. The LPN/LVN places the patient in a Fowler’s position for meals.
ANS: A
The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate
Several hours after an open surgical repair of an abdominal aortic aneurysm, the UAP reports to the nurse that urinary output for the past 2 hours has been 40 mL. The nurse notifies the health care provider and anticipates an order for a(n) a. hemoglobin count. b. additional antibiotic. c. decrease in IV infusion rate. d. blood urea nitrogen (BUN) level.
ANS: D
The decreased urine output suggests decreased renal perfusion, and monitoring of renal function is needed. There is no indication that infection is a concern, so antibiotic therapy and a WBC count are not needed. The IV rate may be increased because hypovolemia may be contributing to the patient’s decreased urinary output
When caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, which
assessment finding is most important for the nurse to communicate to the health care provider?
a. Presence of flatus
b. Loose, bloody stools
c. Hypoactive bowel sounds
d. Abdominal pain with palpation
ANS: B
Loose, bloody stools at this time may indicate intestinal ischemia or infarction, and should be reported immediately because the patient may need an emergency bowel resection. The other findings are normal on the first postoperative day after abdominal surgery
When developing a teaching plan for a 76-year-old patient newly diagnosed with peripheral artery disease (PAD), which instructions 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 elastic compression stockings on early in the morning.”
ANS: B
Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD
When discussing risk factor modification for a 63-year-old patient who has a 5-cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which patient risk factor?
a. Male gender
b. Turner syndrome
c. Abdominal trauma history
d. Uncontrolled hypertension
ANS: D
All of the factors contribute to the patient’s risk, but only
hypertension can potentially be modified to decrease the
patient’s risk for further expansion of the aneurysm.
When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD), the nurse
determines a need for further instruction when the patient says, “I will
a. have to buy some loose clothes that do not bind across my legs or waist.”
b. use a heating pad on my feet at night to increase the circulation and warmth in my feet.”
c. change my position every hour and avoid long periods of sitting with my legs crossed.”
d. walk to the point of pain, rest, and walk again until the pain returns for at least 30 minutes 3 times a week.”
ANS: B
Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful
Which nursing action should be included in the plan of care after endovascular repair of an abdominal aortic aneurysm?
a. Record hourly chest tube drainage.
b. Monitor fluid intake and urine output.
c. Check the abdominal incision for any redness.
d. Teach the reason for a prolonged recovery period.
ANS: B
Because renal artery occlusion can occur after endovascular repair, the nurse should monitor parameters of renal function such as intake
and output. Chest tubes will not be needed for endovascular surgery, the recovery period will be short, and there will not be an abdominal wound
Which nursing intervention for a patient who had an open repair of an abdominal aortic aneurysm 2 days previously is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?
a. Monitor the quality and presence of the pedal pulses.
b. Teach the patient the signs of possible wound infection.
c. Check the lower extremities for strength and movement.
d. Help the patient to use a pillow to splint while coughing.
ANS: D
Assisting a patient who has already been taught how to cough is part of routine postoperative care and within the education and scope of practice for UAP. Patient teaching and assessment of essential postoperative functions such as circulation and movement should be done by RNs
A 56-year-old patient who has no previous history of hypertension or other health problems suddenly
develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that
a. a BP recheck should be scheduled in a few weeks.
b. dietary sodium and fat content should be decreased.
c. there is an immediate danger of a stroke and hospitalization will be required.
d. diagnosis of a possible cause, treatment, and ongoing monitoring will be needed
ANS: D
A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need treatment and ongoing monitoring. If the patient has no other risk factors, a
stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level
During change-of-shift report, the nurse obtains the following information about a hypertensive patient
who received the first dose of nadolol (Corgard) during the previous shift. Which information indicates
that the patient needs immediate intervention?
a. The patient’s most recent blood pressure (BP) reading is 158/91 mm Hg.
b. The patient’s pulse has dropped from 68 to 57 beats/minute.
c. The patient has developed wheezes throughout the lung fields.
d. The patient complains that the fingers and toes feel quite cold.
ANS: C
The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective b-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with b-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated. However, this is not as urgently needed as addressing the bronchospasm
The nurse has just finished teaching a hypertensive patient about the newly prescribed ramipril (Altace). Which patient statement indicates that more teaching is needed?
a. “A little swelling around my lips and face is okay.”
b. “The medication may not work as well if I take any aspirin.”
c. “The doctor may order a blood potassium level occasionally.”
d. “I will call the doctor if I notice that I have a frequent cough.”
ANS: A
Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be
immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy
The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a
hypertensive emergency. Which finding is most important to report to the health care provider?
a. Urine output over 8 hours is 250 mL less than the fluid intake.
b. The patient cannot move the left arm and leg when asked to do so.
c. Tremors are noted in the fingers when the patient extends the arms.
d. The patient complains of a headache with pain at level 8/10 (0 to 10 scale).
ANS: B
The patient’s inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations are also likely caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes
The nurse on the intermediate care unit received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first?
a. 43-year-old with a (blood pressure (BP) of 160/92 who is complaining of chest pain
b. 52-year-old with a BP of 212/90 who has intermittent claudication
c. 50-year-old with a BP of 190/104 who has a creatinine of 1.7 mg/dL
d. 48-year-old with a BP of 172/98 whose urine shows microalbuminuria
ANS: A
The patient with chest pain may be experiencing acute
myocardial infarction, and rapid assessment and intervention are needed. The symptoms of the other patients also show target organ damage but are not indicative of acute processes
A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme
(ACE) inhibitor arrives in the emergency department complaining of a severe headache and nausea and
has a blood pressure (BP) of 238/118 mm Hg. Which question should the nurse ask first?
a. “Did you take any acetaminophen (Tylenol) today?”
b. “Have you been consistently taking your medications?”
c. “Have there been any recent stressful events in your life?”
d. “Have you recently taken any antihistamine medications?”
ANS: B
Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not
increase BP. Stressful events will increase BP but not usually to the level seen in this patient
The registered nurse (RN) is caring for a patient with a hypertensive crisis who is receiving sodium
nitroprusside (Nipride). Which nursing action can the nurse delegate to an experienced licensed
practical/vocational nurse (LPN/LVN)?
a. Titrate nitroprusside to decrease mean arterial pressure (MAP) to 115 mm Hg.
b. Evaluate effectiveness of nitroprusside therapy on blood pressure (BP).
c. Set up the automatic blood pressure machine to take BP every 15 minutes.
d. Assess the patient’s environment for adverse stimuli that might increase BP.
ANS: C
LPN/LVN education and scope of practice include the correct use of common equipment such as automatic blood pressure machines. The other actions require advanced nursing judgment and education, and should be done by RNs