CH 41: Aortic Aneurysms Flashcards

Question

A 55-year-old male with a history of smoking and hypertension reports coughing, shortness of breath, and difficulty swallowing. A thoracic aortic aneurysm is suspected. Which assessment finding would best confirm this diagnosis? A. Diminished breath sounds in the lower lung fields B. Widened mediastinum on chest X-ray C. Positive sputum culture for bacteria D. Hyperresonance on lung percussion

Answer 1

B. Widened mediastinum on chest X-ray Rationale: A widened mediastinum on chest X-ray is a classic finding of a thoracic aortic aneurysm (TAA).

Answer 2

B. “Since my aneurysm is small, I don’t need to follow up with my provider regularly.” D. “As long as I don’t feel any symptoms, my aneurysm is not growing.” Rationale: * (B) Incorrect—Even small AAAs require regular monitoring to assess for growth and risk of rupture. * (D) Incorrect—Many AAAs are asymptomatic, but they can still expand and rupture without warning.

Answer 3

B. Ruptured abdominal aortic aneurysm (AAA) Rationale: Grey Turner sign (flank bruising) with severe back pain is highly suggestive of retroperitoneal hemorrhage due to a ruptured AAA. Surrounding structures may temporarily contain the bleeding, delaying complete exsanguination.

Answer 4

A. Tachycardia B. Hypotension D. Decreased urine output E. Altered level of consciousness Rationale: Massive hemorrhage from an aneurysm rupture leads to hypovolemic shock, which presents with: * Tachycardia (A) as a compensatory mechanism to maintain perfusion. * Hypotension (B) due to blood loss. * Decreased urine output (D) from poor renal perfusion. * Altered level of consciousness (E) from decreased cerebral perfusion.

Answer 5

B. Initiate fluid resuscitation with IV crystalloids Rationale: The patient is exhibiting signs of hypovolemic shock from a suspected aneurysm rupture. Immediate fluid resuscitation with IV crystalloids is the priority to support circulation and maintain perfusion while preparing for surgical intervention.

Answer 6

A. Acute kidney injury Rationale: Prolonged hypotension and hemorrhage lead to decreased renal perfusion, increasing the risk for acute kidney injury (AKI) due to ischemia of the renal tubules.

Answer 7

A. New onset severe back pain C. Pulsatile abdominal mass D. Drop in blood pressure E. Flank ecchymosis Rationale: Warning signs of an impending aneurysm rupture include: * New onset severe back pain (A) from expansion or impending rupture. * Pulsatile abdominal mass (C) suggests an enlarging AAA. * Drop in blood pressure (D) may indicate hemorrhage. * Flank ecchymosis (E) (Grey Turner sign) suggests retroperitoneal bleeding.

Answer 8

A. “Since your aneurysm is over 5 cm, the risk of rupture is high.” Rationale: Aneurysms larger than 5 cm have a significantly increased risk of rupture, and the risk rises further as size increases. Tobacco use is the most important modifiable risk factor, increasing rupture likelihood.

Answer 9

C. CT scan with contrast Rationale: A CT scan with contrast is the gold standard for diagnosing aortic aneurysms. It provides detailed imaging of the aneurysm’s size, location, and involvement of surrounding structures, allowing for surgical planning if needed.

Answer 10

A. Abdominal ultrasound B. CT scan C. MRI Rationale: * Abdominal ultrasound (A) is the initial screening tool for AAA and is used for routine monitoring. * CT scan (B) provides detailed size and anatomical information for surgical planning. * MRI (C) can be used if contrast dye is contraindicated (e.g., renal impairment). * A 12-lead ECG (D) is done to rule out MI but does not diagnose aneurysms. * Pulmonary function tests (E) are unrelated to aneurysm diagnosis.

Answer 11

C. “We needed to rule out a heart attack, since aneurysm pain can mimic angina.” Rationale: Thoracic aortic aneurysm (TAA) can present with chest pain similar to angina or an MI. An ECG is done to rule out cardiac ischemia before proceeding with aneurysm-specific imaging, such as a CT scan or MRI.

Answer 12

D. Abdominal ultrasound Rationale: Abdominal ultrasound is the preferred screening tool for AAA, especially in men aged 65-75 who have ever smoked or have a family history. It is non-invasive, cost-effective, and reliable for detecting aneurysm size.

Answer 13

A. Encouraging tobacco cessation Rationale: Tobacco use is the most important modifiable risk factor for aneurysm growth and rupture. Stopping smoking slows the progression of the aneurysm. Conservative management is recommended for small aneurysms (<5.4 cm) unless symptoms develop or rapid expansion occurs.

Answer 14

A. Monitor BP regularly and take antihypertensives as prescribed. C. Increase physical activity gradually. E. Report any new abdominal or back pain immediately. Rationale: * A. BP control is essential to prevent aneurysm expansion. * C. Gradually increasing physical activity is beneficial for overall cardiovascular health. * E. New or worsening pain can indicate aneurysm expansion or impending rupture. * B. Aneurysms <4.0 cm should be monitored every 3 years, not every 6 months. * D. Statins are recommended to manage hyperlipidemia and reduce cardiovascular risk.

Answer 15

C. Diagnosis of Marfan syndrome Rationale: Patients with genetic disorders like Marfan or Ehlers-Danlos syndrome have a higher risk of rupture even at smaller aneurysm sizes, so they require earlier surgical intervention.

Answer 16

A. ACE inhibitor Rationale: ACE inhibitors reduce hypertension and may help slow aneurysm expansion. They also have protective effects on the vascular endothelium.

Answer 17

A. Assessment of carotid artery disease B. History of coronary artery disease (CAD) C. Presence of diabetes mellitus Rationale: * A. Carotid artery disease should be assessed because severe stenosis may require intervention before aneurysm surgery. * B. CAD increases surgical risk and may require preoperative optimization. * C. Diabetes management is critical to reduce complications during and after surgery. * D. Oxygen saturation is important but not a primary surgical consideration. * E. Thyroid disease is unrelated to aneurysm management.

Answer 18

C. Every 6 to 12 months Rationale: For aneurysms between 4.0 and 5.4 cm, ultrasound or CT should be done every 6 to 12 months to monitor for growth. Aneurysms <4.0 cm are monitored every 3 years.

Answer 19

B. “Maintaining good blood pressure and cholesterol control is essential.” Rationale: Hypertension and hyperlipidemia accelerate aneurysm growth. Managing these risk factors can slow progression and reduce the likelihood of rupture.

Answer 20

B. Ensuring the patient is well hydrated with stable electrolytes Rationale: Adequate hydration, normal electrolyte levels, and a stable hematocrit reduce the risk of complications during and after surgery. Proper fluid balance prevents acute kidney injury (AKI), which is a major risk when the aorta is clamped for an extended period.

Answer 21

A. Baseline renal function tests B. Coagulation profile C. Neurological assessment E. Pulmonary function tests Rationale: * A. Renal function tests (BUN, creatinine) are crucial because prolonged aortic clamping can lead to acute kidney injury. * B. A coagulation profile is necessary to prevent excessive bleeding during surgery. * C. Neurological assessment is important since aneurysms affecting the aortic arch can impact cerebral perfusion. * E. Pulmonary function tests help assess risk for postoperative respiratory complications, especially in patients with preexisting lung disease. * D. Serum albumin is not a priority unless malnutrition is suspected.

Answer 22

A. Monitoring urine output closely Rationale: Clamping the aorta above the renal arteries during surgery increases the risk of acute kidney injury (AKI). The nurse must monitor urine output closely, as decreased output (<30 mL/hr) may indicate impaired renal perfusion.

Answer 23

A. Sudden severe abdominal or back pain C. Decreased urine output E. Numbness or tingling in the legs Rationale: * A. Sudden severe abdominal or back pain may indicate graft rupture or bleeding. * C. Decreased urine output may suggest acute kidney injury from impaired renal perfusion. * E. Numbness or tingling in the legs could indicate impaired blood flow or nerve damage. * B. Redness and warmth at the incision site may indicate infection but is not an emergency. * D. Mild nausea and bloating can occur postoperatively but is not a priority concern.

Answer 24

B. Spinal cord ischemia Rationale: Cross-clamping the aorta for an extended period can reduce blood flow to the spinal cord, leading to ischemia and possible paralysis. The risk is higher in thoracic aneurysm repairs.

Answer 25

D. To replace the entire diseased arterial segment Rationale: A bifurcated graft is used when aneurysms involve the iliac arteries, replacing the diseased segment entirely. This ensures restored circulation to both lower extremities.

Answer 26

A. Increase IV fluid rate as ordered Rationale: Decreased urine output and rising BUN/creatinine levels indicate impaired renal perfusion. Increasing IV fluids improves renal blood flow and may prevent acute kidney injury.

Answer 27

C. The patient’s iliac vessels are large enough to allow graft insertion Rationale: Endovascular graft procedure (EVAR) requires that the iliac vessels are of adequate size and shape to allow safe graft insertion. Calcification, occlusion, or other significant vessel abnormalities would preclude EVAR.

Answer 28

D. EVAR is less invasive and associated with fewer complications than OAR Rationale: EVAR is a minimally invasive procedure compared to OAR, which involves a large abdominal incision. EVAR has fewer complications, such as paraplegia, and typically results in a shorter hospital stay.

Answer 29

A. Endograft migration B. Rupture of the aneurysm D. Graft infection E. Leaks at the graft site Rationale: * A. Endograft migration may occur if the graft does not securely adhere to the vessel wall. * B. Rupture of the aneurysm is still a risk if the graft is not placed properly or develops leaks. * D. Graft infection is a potential risk as the graft is a foreign object inserted into the body. * E. Leaks at the graft site can occur, which may compromise the repair and require additional intervention.

Answer 30

B. Notify the healthcare provider for potential graft complication Rationale: A pulsatile mass near the graft site may indicate a graft leak or other complications that require immediate evaluation by the healthcare provider.

Answer 31

A. To confirm the patency and position of the graft Rationale: Angiography is performed after EVAR to confirm that the graft is properly positioned and functioning, ensuring there are no leaks or obstructions.

Answer 32

B. Monitoring for signs of graft rupture or migration Rationale: After EVAR, the most significant concern is graft integrity, which includes monitoring for graft rupture or migration. Prompt detection is essential to prevent aneurysm rupture.

Answer 33

D. Ensuring the patient’s vessels are of adequate size for graft insertion Rationale: Successful graft insertion depends on the size and integrity of the iliac vessels. If the vessels are too small or too calcified, the patient may not be eligible for EVAR.

Answer 34

B. Endoleak Rationale: Endoleak is the most common complication after AAA repair, where blood seeps back into the old aneurysm. This complication may require further intervention such as coil embolization for hemostasis.

Answer 35

A. Administering thrombolytic therapy to dissolve the clot Rationale: Graft thrombosis can be treated with thrombolytic therapy to dissolve the clot, allowing for restoration of blood flow through the graft. Immediate surgery may be required if thrombolysis is unsuccessful.

Answer 36

C. Abdominal compartment syndrome Rationale: Abdominal compartment syndrome is a life-threatening complication of AAA repair that leads to multisystem organ failure due to intraabdominal hypertension (IAH), reducing blood flow to vital organs.

Answer 37

A. Back pain and hypotension C. Pulsatile mass at the graft site E. Bruit over the aorta Rationale: * A. Back pain and hypotension may be signs of bleeding or an endoleak. * C. Pulsatile mass at the graft site could indicate an endoleak or other complications, such as a graft issue. * E. Bruit over the aorta suggests turbulent blood flow, which can be caused by an endoleak.

Answer 38

C. Abdominal compartment syndrome Rationale: Abdominal compartment syndrome can develop rapidly after AAA repair and lead to multisystem organ failure. Monitoring for signs of intraabdominal hypertension (IAH) is critical in the first 24 hours.

Answer 39

A. Notify the healthcare provider about possible graft rupture Rationale: Back pain and hypotension following AAA repair could indicate graft rupture, which requires immediate medical intervention to prevent hemorrhagic shock and other life-threatening complications.

Answer 40

B. Initiating percutaneous drainage and possibly thrombolytic Rationale: The treatment for IAH may involve surgical decompression, percutaneous drainage, and thrombolytic therapy to reduce intraabdominal pressure and prevent multisystem organ failure.

Answer 41

D. Periodic imaging to monitor for endoleak or aneurysm expansion Rationale: Periodic imaging (such as ultrasound or CT) is required to monitor for complications like endoleak or aneurysm growth following EVAR. This ensures early detection and timely intervention to prevent rupture.

Answer 42

C. Tachycardia, hypotension, and changes in level of consciousness Rationale: Tachycardia, hypotension, and changes in level of consciousness are signs of hemorrhagic shock associated with aortic aneurysm rupture, requiring immediate intervention to prevent death.

Answer 43

D. Encouraging cessation of smoking Rationale: Smoking cessation is a priority as it is a significant risk factor for aortic aneurysm development and rupture. It also contributes to poor graft patency and worsens cardiovascular disease.

Answer 44

B. Pale skin and absent pedal pulses C. Changes in level of consciousness and groin pain D. A pulsating abdominal mass and hypotension E. Decreased urine output and tachycardia Rationale: * B. Pale skin and absent pedal pulses could indicate poor circulation and compromise to peripheral perfusion. * C. Changes in level of consciousness and groin pain are concerning for a ruptured aneurysm. * D. A pulsating abdominal mass and hypotension are classic signs of an impending rupture. * E. Decreased urine output and tachycardia could suggest shock or renal compromise, both of which require immediate intervention.

Answer 45

D. The patient’s peripheral pulses and renal function Rationale: Peripheral pulses and renal function are critical indicators of adequate tissue perfusion after aortic aneurysm surgery. Monitoring these helps detect complications such as renal failure or impaired blood flow to extremities.

Answer 46

A. Encouraging smoking cessation Rationale: Smoking cessation is a critical intervention for reducing CVD risk and preventing aortic aneurysm rupture. It improves vascular health, enhances graft patency, and reduces the likelihood of complications.

Answer 47

A. Encouraging the patient to quit smoking immediately Rationale: Smoking cessation has the most immediate and significant impact on preventing aneurysm rupture and improving surgical outcomes. Encouraging this behavior change should be a top priority.

Answer 48

D. Ensuring the patient is well-hydrated and has normal electrolytes Rationale: Adequate hydration and normal electrolyte levels are essential for ensuring the patient’s stability before aortic aneurysm surgery, especially since the surgery involves major vascular repair and the risk of fluid imbalances is high.

Answer 49

D. All of the above Rationale: After aortic aneurysm surgery, the patient will have various monitoring devices in place, including an arterial line, CVP catheter, chest tube (if thorax is opened), lumbar catheter for cerebrospinal fluid drainage, peripheral IV lines, and an NG tube to monitor and support post-operative care.

Answer 50

B. Ensuring the patient is NPO after midnight Rationale: NPO status after midnight helps prevent aspiration during surgery. While β-blockers and IV antibiotics are also part of the plan of care, NPO status is the most critical preoperative action for patient safety.

Answer 51

A. Maintaining adequate respiratory function B. Monitoring for graft patency and renal perfusion D. Administering pain medications via IV PCA E. Ensuring continuous ECG and pulse oximetry monitoring Rationale: Postoperative care involves maintaining respiratory function, ensuring graft patency, renal perfusion, and continuous monitoring (ECG and pulse oximetry). While early ambulation is important for recovery, it is not the top priority immediately after surgery. Pain control is crucial for patient comfort and recovery.

Answer 52

A. Impaired renal perfusion due to graft occlusion Rationale: Impaired renal perfusion can occur due to complications such as graft occlusion or hypotension postoperatively, leading to decreased urinary output. This is a key complication to monitor for in these patients.

Answer 53

A. Neurologic complications, including stroke or paraplegia Rationale: Neurologic complications such as stroke or paraplegia are serious postoperative risks, especially in patients who have had thoracic or abdominal aortic aneurysm repair. Monitoring for these complications is critical, especially in patients with lumbar catheters to prevent cerebrospinal fluid-related issues.

Answer 54

D. Assess the patient’s respiratory status for signs of opioid overdose Rationale: Since the patient is receiving opioids via PCA, it is critical to monitor for signs of opioid overdose, such as respiratory depression. Regular assessment of pain is also important, but the primary focus should be on preventing respiratory complications.

Answer 55

A. Administering a β-blocker to reduce heart rate and myocardial oxygen demand Rationale: β-blockers are commonly prescribed to reduce myocardial oxygen demand and heart rate, which can help prevent cardiac ischemia following aortic aneurysm surgery, especially in patients with pre-existing cardiovascular disease.

Answer 56

C. Notify the surgeon immediately for further evaluation Rationale: Infection at the surgical site is a serious complication that can impair healing and lead to systemic infection. Notifying the surgeon is the priority action to ensure appropriate treatment and potential surgical intervention.

Answer 57

A. Monitoring the patient’s blood pressure to ensure it is within normal limits Rationale: Blood pressure control is critical to maintaining graft patency. Prolonged low blood pressure may result in graft thrombosis, while severe hypertension may lead to stress on the graft, increasing the risk of rupture or leakage at the anastomoses.

Answer 58

A. Increase IV fluid administration as ordered Rationale: Hypotension can impair graft perfusion and lead to graft thrombosis. Increasing IV fluid administration will help maintain adequate blood flow and support graft patency by restoring blood pressure and perfusion.

Answer 59

B. Maintain blood pressure within normal limits and avoid severe hypertension Rationale: Maintaining blood pressure within normal limits is crucial to prevent graft rupture. Severe hypertension may place stress on the arterial anastomoses and increase the risk of leakage or rupture at the suture lines.

Answer 60

A. Monitor CVP or PA pressures hourly B. Administer IV antihypertensive agents as needed to control high blood pressure D. Assess urine output hourly to monitor kidney perfusion Rationale: Monitoring CVP or PA pressures and urine output hourly, along with administering IV antihypertensive agents if necessary, are essential to assess and maintain graft patency and adequate hydration and perfusion. Pain management is important for comfort, but it is not directly related to graft patency. Bed rest is not specifically required to prevent graft displacement.

Answer 61

C. Monitor the patient’s ECG continuously Rationale: Continuous ECG monitoring is essential to detect myocardial ischemia or dysrhythmias that may occur in the perioperative period due to decreased myocardial oxygen supply or increased oxygen demand. This allows for early intervention to prevent complications.

Answer 62

A. Potassium Rationale: Potassium is essential for electrical conduction in the heart. Electrolyte imbalances in potassium, particularly hypokalemia, can lead to dysrhythmias, so careful monitoring and correction of potassium levels is critical in preventing complications.

Answer 63

A. Heart rate and rhythm Rationale: Monitoring heart rate and rhythm is essential to detect dysrhythmias, which can occur due to myocardial ischemia or the use of antidysrhythmic medications. This allows for early identification and treatment of complications related to the heart’s electrical conduction.

Answer 64

A. Administer O2 as ordered B. Provide pain management as needed C. Monitor electrolyte levels frequently E. Administer IV antihypertensive medications if the patient becomes hypertensive Rationale: The nurse should administer oxygen to optimize myocardial oxygenation, provide pain management to reduce stress on the heart, monitor electrolyte levels to detect imbalances that could cause dysrhythmias, and administer IV antihypertensives as needed to prevent excessive hypertension that could increase myocardial oxygen demand. Deep breathing exercises may be helpful, but they are not a primary intervention for myocardial ischemia or dysrhythmias.

Answer 65

A. Administer antibiotics as prescribed Rationale: The administration of broad-spectrum antibiotics as prescribed is critical in preventing infection following vascular graft surgery. Infection is a serious complication, and antibiotics help reduce the risk of bacterial invasion.

Answer 66

B. Immediately report the fever to the provider as it may indicate infection Rationale: A fever following vascular graft surgery may indicate an infection. Prompt reporting to the provider allows for early diagnosis and treatment, as infection is a life-threatening complication.

Answer 67

C. Assess the incision site for signs of infection Rationale: A high WBC count is an early sign of infection, and assessing the incision site for signs of infection (e.g., redness, swelling, drainage) is crucial for identifying a potential problem and providing appropriate care.

Answer 68

A. Perform wound care as prescribed B. Ensure good hand-washing and strict aseptic technique C. Remove urinary catheter as soon as possible D. Keep the surgical incisions clean and dry Rationale: Wound care as prescribed, aseptic technique, early catheter removal, and keeping the surgical incisions clean and dry all contribute to minimizing the risk of infection. Limiting oral intake does not directly affect infection prevention.

Answer 69

C. Perform meticulous perineal care Rationale: Meticulous perineal care is essential to reduce the risk of urinary tract infection in patients with an indwelling urinary catheter. Regular catheter care helps prevent bacterial contamination, which is a major cause of UTIs.

Answer 70

A. Encourage early ambulation Rationale: Early ambulation is essential to promote the return of bowel function after surgery. It helps stimulate peristalsis and reduces the risk of developing postoperative ileus.

Answer 71

D. To prevent aspiration of stomach contents Rationale: An NG tube connected to low, intermittent suction is used to decompress the stomach, prevent aspiration of stomach contents, and reduce pressure on the surgical site, thus helping to protect the suture lines.

Answer 72

C. Bowel ischemia or infarction Rationale: The absence of bowel sounds, fever, abdominal distention, and pain are indicative of bowel ischemia or infarction. Immediate reoperation is required if bowel infarction is suspected to restore blood flow and remove the infarcted tissue.

Answer 73

A. Record the amount and character of NG output B. Encourage the patient to ambulate early D. Provide frequent oral care Rationale: The nurse should record the NG output, encourage early ambulation to promote bowel function, and provide frequent oral care for comfort. Laxatives and solid food are not appropriate until bowel function returns.

Answer 74

B. Monitor for signs of bowel ischemia or infarction Rationale: The absence of flatus after 48 hours may indicate complications such as bowel ischemia or infarction, which requires careful monitoring for other signs (e.g., fever, abdominal pain). Immediate intervention may be necessary if ischemia is suspected.

Answer 75

B. Abdominal distention and passing flatus Rationale: In a postoperative ileus, abdominal distention and passing flatus are signs that the bowel is beginning to function again. It is important to monitor this condition and provide support to encourage bowel movement.

Answer 76

C. Weakness in the right upper extremity Rationale: Any neurologic deficit, such as weakness in the upper extremity, indicates potential complications after surgery involving the ascending aorta and aortic arch, such as stroke or other neurologic events. Immediate notification to the HCP is necessary for further evaluation.

Answer 77

A. Absent pedal pulses in both feet Rationale: Absent pedal pulses in the lower extremities may indicate a vascular complication or neurovascular compromise following surgery involving the descending aorta, which requires immediate intervention and assessment.

Answer 78

D. Notify the healthcare provider immediately Rationale: Slurred speech and inability to move the right arm are signs of possible neurologic complications such as stroke. The nurse should notify the healthcare provider immediately for further evaluation and management.

Answer 79

B. Carotid, radial, temporal Rationale: When the ascending aorta and aortic arch are involved, the nurse should assess the carotid, radial, and temporal artery pulses to monitor peripheral perfusion status.

Answer 80

A. Assess the femoral, popliteal, posterior tibial, and dorsalis pedis pulses C. Measure capillary refill time D. Check for skin temperature and color Rationale: After surgery on the descending aorta, the nurse should assess the femoral, popliteal, posterior tibial, and dorsalis pedis pulses and monitor capillary refill, skin temperature, and color to ensure adequate peripheral perfusion. Level of consciousness and respiratory rate are important for overall monitoring but are not part of a peripheral perfusion assessment.

Answer 81

C. Notify the healthcare provider immediately Rationale: Absent pulses, along with a cool, pale, mottled, and painful extremity, may indicate embolization or graft occlusion, which requires immediate attention and reoperation if identified early.

Answer 82

C. Absent femoral pulses, cool, pale extremity, and pain Rationale: Absent femoral pulses along with a cool, pale extremity and pain could indicate embolization or graft occlusion, which requires immediate intervention to avoid further complications.

Answer 83

C. Notify the healthcare provider immediately Rationale: Decreased pulses and cool extremities following descending aorta surgery could be signs of embolization or graft occlusion. Immediate notification to the healthcare provider is essential for further assessment and intervention.

Answer 84

A. Hourly urine output and daily BUN and serum creatinine levels Rationale: Hourly urine output and monitoring daily BUN and serum creatinine levels are key assessments to evaluate renal perfusion status, as these provide vital information regarding kidney function and hydration.

Answer 85

A. Embolization of an aortic thrombus or plaque to renal arteries B. Hypotension and dehydration C. Prolonged aortic clamping during surgery D. Diabetes Rationale: Embolization, hypotension, dehydration, prolonged aortic clamping, and diabetes are all risk factors for decreased renal perfusion. Increased urinary output is typically not a contributing factor to decreased perfusion.

Answer 86

D. Decreased urine output and elevated BUN and creatinine levels Rationale: Decreased urine output along with elevated BUN and creatinine levels are indicative of renal ischemia and decreased renal perfusion, often due to factors like hypotension or embolization of aortic thrombus.

Answer 87

B. Assess urinary output hourly and monitor BUN and creatinine levels Rationale: Hourly urinary output and monitoring BUN and creatinine levels are critical for detecting renal insufficiency, especially in patients at high risk such as those with diabetes.

Answer 88

B. Gradually increase activities, avoiding heavy lifting for 6 weeks Rationale: It is important for the patient to gradually increase activities and avoid heavy lifting for 6 weeks to prevent strain on the surgical site and allow for proper healing.

Answer 89

A. Redness and swelling around the surgical incision B. Fever greater than 100°F (37.8°C) C. Increased pain at the surgical site Rationale: Redness, swelling, and increased pain at the surgical site, as well as a fever greater than 100°F, are signs of possible infection or complications that require prompt medical attention. Decreased urinary output is also a concern, though not listed in the options. Increased peripheral pulse quality is usually not a concerning finding.

Answer 90

D. Suggest a referral to a urologist and counseling if necessary Rationale: Sexual problems, such as erectile dysfunction, are common after aortic surgery. A referral to a urologist and possibly counseling can be beneficial in addressing these issues.

Answer 91

b. Sudden low back pain and bruising along the flank

Answer 92

c. Administering IV fluids and watching kidney function

Answer 93

b. Hypertension Rationale: Hypertension can potentially be managed to decrease the patient‘s risk for further expansion of the aneurysm. Male gender, older age, and family history are not modifiable risk factors.

Answer 94

b. Difficulty swallowing Rationale: Difficulty swallowing may occur with a thoracic aneurysm because of pressure on the esophagus. The other symptoms would be expected in patients with abdominal aortic aneurysms.

Answer 95

b. Increased IV fluids Rationale: 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.

Answer 96

b. Monitor fluid intake and urine output. Rationale: 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.

Answer 97

b. Check the patient‘s blood pressure. Rationale: 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 may also be done, but they will not provide information to determine what interventions are needed immediately.

Answer 98

b. Notify the surgeon and anesthesiologist. Rationale: 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 would be reported to the surgeon immediately because this is an emergency situation. Because pulses are marked before surgery, the nurse already would know whether pulses were present before surgery. 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.

Answer 99

c. Maroon-colored liquid stool Rationale: Loose, bloody (maroon-colored) stools at this time may indicate intestinal ischemia or infarction and would 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.

Answer 100

d. Help the patient to use a pillow to splint while coughing. Rationale: 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 would be done by RNs.