Chapter 38: Nursing Management: Vascular Disorders Flashcards
- 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 patients risk, but only hypertension can potentially be modified to decrease the patients risk for further expansion of the aneurysm.
- 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.
- 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 patients decreased urinary output.
- 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 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 patients 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.
- 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 Raynauds phenomenon. Tortuous veins on the legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness indicate venous thromboembolism (VTE).
- 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.
- 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.
- After teaching a patient with newly diagnosed Raynauds phenomenon about how to manage the condition, which action by the patient demonstrates that the teaching has been effective?
a.
The patient exercises indoors during the winter months.
b.
The patient places the hands in hot water when they turn pale.
c.
The patient takes pseudoephedrine (Sudafed) for cold symptoms.
d.
The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).
ANS: A
Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the hands. Pseudoephedrine is a vasoconstrictor, and should be avoided. There is no reason to avoid taking NSAIDs with Raynauds phenomenon.
- 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 patients 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 health care provider prescribes an infusion of heparin (Hep-Lock) and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to
a.
decrease the infusion when the PTT value is 65 seconds.
b.
avoid giving any IM medications to prevent localized bleeding.
c.
monitor posterior tibial and dorsalis pedis pulses with the Doppler.
d.
have vitamin K available in case reversal of the heparin is needed.
ANS: B
IM injections are avoided in patients receiving anticoagulation. A PTT of 65 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.
- A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is mostappropriate?
a.
Taking two blood thinners reduces the risk for another clot to form.
b.
Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots from forming.
c.
Lovenox will work right away, but Coumadin takes several days to have an effect on preventing clots.
d.
Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner.
ANS: C
Low molecular weight heparin (LMWH) is used because of the immediate effect on coagulation and discontinued once the international normalized ratio (INR) value indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic properties. The use of two anticoagulants is not related to the risk for pulmonary embolism, and two are not necessary to reduce the risk for another VTE. Furthermore, anticoagulants should not be described as blood thinners.
- The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) following hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says which of the following?
a.
I should get a Medic Alert device stating that I take Coumadin.
b.
I should reduce the amount of green, leafy vegetables that I eat.
c.
I will need routine blood tests to monitor the effects of the Coumadin.
d.
I will check with my health care provider before I begin any new medications.
ANS: B
Patients taking warfarin are taught to follow a consistent diet with regard to foods that are high in vitamin K, such as green, leafy vegetables. The other patient statements are accurate.
- A 46-year-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Which instructions should the nurse provide to the patient before discharge?
a.
Sitting at the work counter, rather than standing, is recommended.
b.
Exercise, such as walking or jogging, can cause recurrence of varicosities.
c.
Elastic compression stockings should be applied before getting out of bed.
d.
Taking an aspirin daily will help prevent clots from forming around venous valves.
ANS: C
Elastic compression stockings are applied with the legs elevated to reduce pressure in the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to prevent venous thrombosis and would not be recommended for the patient who had just had sclerotherapy.
- Which topic should the nurse include in patient teaching for a patient with a venous stasis ulcer on the left lower leg?
a.
Need to increase carbohydrate intake
b.
Methods of keeping the wound area dry
c.
Purpose of prophylactic antibiotic therapy
d.
Application of elastic compression stockings
ANS: D
Compression of the leg is essential to healing of venous stasis ulcers. High dietary intake of protein, rather than carbohydrates, is needed. Prophylactic antibiotics are not routinely used for venous ulcers. Moist dressings are used to hasten wound healing.
