Vascular Flashcards
A patient with peripheral artery disease (PAD) complains of leg pain while walking that is relieved by rest. The nurse identifies this as which symptom?
A. Rest pain
B. Intermittent claudication
C. Neuropathic pain
D. Venous stasis pain
Correct Answer: B. Intermittent claudication
Rationale: Intermittent claudication is a hallmark symptom of PAD, caused by inadequate blood flow to the muscles during exercise. The pain is relieved with rest. Rest pain, in contrast, indicates more severe arterial insufficiency.
A nurse is teaching a patient with PAD about foot care. Which statement by the patient indicates a need for further education?
A. “I will inspect my feet daily for any sores or injuries.”
B. “I should soak my feet in warm water every evening to keep them clean.”
C. “I need to wear well-fitted shoes to prevent foot injuries.”
D. “I should avoid walking barefoot to prevent injuries.”
Correct Answer: B. “I should soak my feet in warm water every evening to keep them clean.”
Rationale: Patients with PAD should avoid soaking their feet because prolonged exposure to water can cause maceration and increase the risk of infection. Proper foot hygiene includes washing with mild soap and warm (not hot) water, drying thoroughly, and moisturizing (avoiding the spaces between the toes).
A patient with a history of deep vein thrombosis (DVT) presents with sudden shortness of breath, chest pain, and hemoptysis. What complication should the nurse suspect?
A. Myocardial infarction
B. Pulmonary embolism
C. Pneumothorax
D. Pleural effusion
Correct Answer: B. Pulmonary embolism
Rationale: Pulmonary embolism (PE) occurs when a clot from a DVT travels to the lungs, blocking pulmonary circulation. Classic signs include sudden dyspnea, chest pain, and hemoptysis. This is a medical emergency.
A patient with a suspected deep vein thrombosis (DVT) presents with unilateral leg swelling, warmth, and tenderness. Which nursing intervention is most appropriate?
A. Massage the affected leg to improve circulation
B. Apply ice packs to reduce swelling
C. Keep the affected leg in a dependent position
D. Maintain bed rest and elevate the leg
Correct Answer: D. Maintain bed rest and elevate the leg
Rationale: Elevation reduces swelling and promotes venous return. Massaging the leg is contraindicated as it may dislodge the clot, leading to a pulmonary embolism.
A patient is prescribed warfarin for long-term anticoagulation therapy after a DVT. Which statement indicates the patient understands the medication instructions?
A. “I will avoid eating green leafy vegetables.”
B. “I will take my medication at the same time every day.”
C. “I need weekly blood draws for INR monitoring.”
D. “If I miss a dose, I should take double the next dose.”
Correct Answer: B. “I will take my medication at the same time every day.”
Rationale: Consistency in taking warfarin is essential for maintaining a therapeutic INR. While patients should limit, not completely avoid, high-vitamin K foods (like leafy greens), frequent INR monitoring is typically needed but not always weekly.
A nurse is reviewing the medication list of a patient on anticoagulation therapy. Which over-the-counter medication should the patient avoid due to increased bleeding risk?
A. Acetaminophen
B. Ibuprofen
C. Loratadine
D. Omeprazole
Correct Answer: B. Ibuprofen
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, increase the risk of bleeding when taken with anticoagulants. Acetaminophen is a safer alternative for pain relief in these patients.
A patient with a recent diagnosis of PAD is advised to start an exercise program. What should the nurse include in the teaching?
A. “Stop exercising as soon as you feel pain in your legs.”
B. “Walking is the best exercise for improving circulation.”
C. “Limit walking to short distances to prevent fatigue.”
D. “Only exercise indoors to avoid temperature changes.”
Correct Answer: B. “Walking is the best exercise for improving circulation.”
Rationale: Walking is the best exercise for PAD as it promotes collateral circulation. Patients should walk until they experience discomfort, rest, and then continue walking again to improve endurance and blood flow.
A patient with a DVT is receiving heparin therapy. Which lab result should the nurse monitor to determine therapeutic effectiveness?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. D-dimer level
Correct Answer: C. Activated partial thromboplastin time (aPTT)
Rationale: aPTT is used to monitor the effectiveness of heparin therapy. Warfarin, in contrast, is monitored using PT and INR.
A patient with peripheral artery disease (PAD) has critical limb ischemia. Which assessment finding requires immediate intervention?
A. Thickened toenails and dependent rubor
B. Pain in the affected limb that is relieved with rest
C. Ulcers on the toes with a pale wound bed
D. Absent pedal pulses and cold, cyanotic toes
Correct Answer: D. Absent pedal pulses and cold, cyanotic toes
Rationale: Absent pulses and cyanotic toes indicate severe arterial insufficiency and possible limb-threatening ischemia. This requires immediate intervention to restore blood flow and prevent necrosis.
A nurse is providing discharge instructions to a patient with venous thromboembolism (VTE) who is prescribed warfarin. Which statement by the patient indicates a need for further teaching?
A. “I will wear compression stockings daily.”
B. “I need to have my INR checked regularly.”
C. “I can take ibuprofen for pain as needed.”
D. “I will avoid prolonged sitting and keep my legs elevated when possible.”
Correct Answer: C. “I can take ibuprofen for pain as needed.”
Rationale: Ibuprofen (an NSAID) increases the risk of bleeding in patients on warfarin. Acetaminophen is a safer alternative for pain relief.
A patient with a suspected pulmonary embolism (PE) is receiving oxygen and anticoagulation therapy. Which assessment finding requires immediate action?
A. Sudden onset of confusion and restlessness
B. Mild pleuritic chest pain with deep breathing
C. SpO₂ of 94% on 2L nasal cannula
D. Low-grade fever of 37.8°C (100°F)
Correct Answer: A. Sudden onset of confusion and restlessness
Rationale: Confusion and restlessness indicate hypoxia, which may suggest worsening PE and impaired oxygenation. This requires immediate intervention.
A nurse is caring for a patient receiving heparin for deep vein thrombosis (DVT). Which finding would require the nurse to stop the infusion and notify the provider?
A. aPTT of 60 seconds
B. Platelet count of 90,000/mm³
C. Hemoglobin of 14 g/dL
D. Bruising at the IV site
Correct Answer: B. Platelet count of 90,000/mm³
Rationale: A platelet count below 100,000/mm³ may indicate heparin-induced thrombocytopenia (HIT), a serious complication requiring immediate discontinuation of heparin.
A patient with chronic venous insufficiency is at risk for venous stasis ulcers. Which nursing intervention is most appropriate?
A. Encourage prolonged sitting with legs dependent
B. Apply moist heat packs to improve circulation
C. Elevate legs above heart level when resting
D. Massage the lower extremities to improve blood flow
Correct Answer: C. Elevate legs above heart level when resting
Rationale: Elevating the legs improves venous return and reduces swelling. Prolonged sitting, heat, and massage are contraindicated due to the risk of clot dislodgment or worsening venous congestion.
A patient receiving enoxaparin (Lovenox) for DVT prevention asks why this medication is necessary after surgery. What is the nurse’s best response?
A. “It helps dissolve any clots that may have formed during surgery.”
B. “It prevents clots from forming by thinning your blood.”
C. “It stops the platelets from sticking together in your arteries.”
D. “It improves circulation by increasing blood flow to your legs.”
Correct Answer: B. “It prevents clots from forming by thinning your blood.”
Rationale: Enoxaparin is a low-molecular-weight heparin that prevents clot formation by inhibiting clotting factors, reducing the risk of DVT after surgery.
A patient with a history of deep vein thrombosis (DVT) is planning to take a long flight. Which teaching point should the nurse emphasize?
A. “Take aspirin before the flight to prevent clotting.”
B. “Remain seated as much as possible during the flight.”
C. “Wear compression stockings and perform leg exercises.”
D. “Drink caffeinated beverages to keep blood circulating.”
Correct Answer: C. “Wear compression stockings and perform leg exercises.”
Rationale: Wearing compression stockings and performing leg exercises help promote venous return and prevent DVT during prolonged immobility.
A nurse is monitoring a patient receiving thrombolytic therapy for a massive pulmonary embolism (PE). Which finding is most concerning?
A. Epistaxis (nosebleed)
B. Pink-tinged sputum
C. Sudden decrease in level of consciousness
D. Bruising at the IV site
Correct Answer: C. Sudden decrease in level of consciousness
Rationale: A sudden decrease in LOC may indicate intracranial bleeding, a serious complication of thrombolytic therapy. This requires immediate intervention.
A nurse is caring for a patient with peripheral artery disease (PAD). Which statement by the patient requires further teaching?
A. “I should avoid crossing my legs when sitting.”
B. “I will keep my legs elevated when resting.”
C. “I will quit smoking to help improve my circulation.”
D. “I will check my feet daily for any wounds or changes.
Correct Answer: B. “I will keep my legs elevated when resting.”
Rationale: Elevating the legs reduces venous congestion but worsens arterial circulation in PAD. Patients should keep their legs in a dependent position to promote blood flow
A patient with a newly diagnosed deep vein thrombosis (DVT) is prescribed warfarin and enoxaparin. The patient asks why they are taking both medications. What is the best response?
A. “Warfarin works immediately, while enoxaparin helps prevent clots.”
B. “Enoxaparin works right away, and warfarin takes a few days to be effective.”
C. “Both medications work the same way, so they are given together for better results.”
D. “Warfarin prevents new clots, while enoxaparin helps dissolve the existing clot.”
Correct Answer: B. “Enoxaparin works right away, and warfarin takes a few days to be effective.”
Rationale: Warfarin takes several days to reach a therapeutic INR level, so enoxaparin (a low-molecular-weight heparin) is used as a bridge therapy until warfarin becomes effective.
A nurse is reviewing discharge instructions with a patient who has a venous ulcer due to chronic venous insufficiency. Which statement indicates a need for further teaching?
A. “I will keep my legs elevated as much as possible.”
B. “I should apply a heating pad to improve circulation.”
C. “I will wear compression stockings daily.”
D. “I should report any signs of infection, such as redness or drainage.”
Correct Answer: B. “I should apply a heating pad to improve circulation.”
Rationale: Applying heat is contraindicated as it may cause burns due to impaired sensation in affected areas. Instead, compression and leg elevation are key to improving circulation.
A patient is diagnosed with heparin-induced thrombocytopenia (HIT). Which action should the nurse take first?
A. Continue monitoring platelet counts
B. Administer vitamin K
C. Stop the heparin infusion immediately
D. Prepare to administer a platelet transfusion
Correct Answer: C. Stop the heparin infusion immediately
Rationale: HIT is a serious immune-mediated reaction that increases the risk of thrombosis. The first priority is stopping heparin and switching to an alternative anticoagulant.
A nurse is caring for a patient with a history of peripheral artery disease (PAD). Which intervention should the nurse implement to promote circulation?
A. Apply warm compresses to the affected extremity
B. Encourage the patient to dangle their legs when sitting
C. Elevate the legs above heart level
D. Massage the affected limb to improve blood flow
Correct Answer: B. Encourage the patient to dangle their legs when sitting
Rationale: Patients with PAD should keep their legs in a dependent position (dangling) to improve arterial blood flow. Elevating the legs above heart level is appropriate for venous insufficiency but not for PAD. Warm compresses and massage can worsen ischemia and should be avoided.
A nurse is assessing a patient with a suspected deep vein thrombosis (DVT). Which finding requires immediate intervention?
A. Unilateral leg swelling and redness
B. Positive Homan’s sign
C. New onset of shortness of breath and chest pain
D. Warmth over the affected calf
Correct Answer: C. New onset of shortness of breath and chest pain
Rationale: Sudden shortness of breath and chest pain may indicate a pulmonary embolism (PE), a life-threatening complication of DVT. This requires immediate intervention.
A patient is receiving warfarin for DVT treatment. Which patient statement indicates a need for further teaching?
A. “I will avoid green leafy vegetables in my diet.”
B. “I should have my INR checked regularly.”
C. “I will take my medication at the same time every day.”
D. “I should report any unusual bleeding or bruising to my doctor.”
Correct Answer: A. “I will avoid green leafy vegetables in my diet.”
Rationale: Patients on warfarin should maintain a consistent intake of vitamin K foods (e.g., leafy greens), not avoid them completely. INR monitoring is essential to ensure proper anticoagulation.
A patient with a history of DVT is preparing for a long car trip. Which action should the nurse recommend to reduce the risk of another clot?
A. Take aspirin before the trip
B. Wear compression stockings and take breaks to walk
C. Keep legs in a dependent position while sitting
D. Avoid drinking fluids to reduce swelling
Correct Answer: B. Wear compression stockings and take breaks to walk
Rationale: Compression stockings and frequent movement help prevent venous stasis and reduce the risk of DVT. Keeping the legs dependent and dehydration increase clot risk.
A nurse is caring for a post-operative patient receiving low-molecular-weight heparin (LMWH). Which assessment requires immediate intervention?
A. Platelet count of 100,000/mm³
B. Mild bruising at the injection site
C. Sudden onset of dark, tarry stools
D. aPTT of 35 seconds
Correct Answer: C. Sudden onset of dark, tarry stools
Rationale: Dark, tarry stools (melena) suggest gastrointestinal bleeding, a potential complication of anticoagulation therapy. This requires immediate evaluation.
A nurse is teaching a patient with chronic venous insufficiency about self-care. Which statement by the patient indicates correct understanding?
A. “I should sit with my legs down as much as possible.”
B. “I will wear compression stockings daily.”
C. “I should avoid elevating my legs to prevent swelling.”
D. “I will limit my fluid intake to reduce swelling.”
Correct Answer: B. “I will wear compression stockings daily.”
Rationale: Compression stockings improve venous return, reducing swelling and preventing ulcers. Leg elevation is encouraged, and fluid restriction is not necessary.
A patient with a recent DVT is prescribed rivaroxaban. Which statement by the patient indicates a need for further education?
A. “I don’t need regular blood tests with this medication.”
B. “I will take this medication with food.”
C. “I should avoid aspirin and NSAIDs.”
D. “I can stop taking this medication if my symptoms go away.”
Correct Answer: D. “I can stop taking this medication if my symptoms go away.”
Rationale: Rivaroxaban (a Factor Xa inhibitor) should not be stopped suddenly without medical supervision, as this increases the risk of recurrent DVT or PE.
A nurse is evaluating a patient’s response to heparin therapy for DVT. Which lab value suggests that the medication is effective?
A. INR of 3.5
B. Platelet count of 150,000/mm³
C. aPTT of 65 seconds
D. D-dimer level of 1.0 mg/L
Correct Answer: C. aPTT of 65 seconds
Rationale: Heparin is monitored using aPTT, which should be 1.5 to 2.5 times the normal range (approximately 60–80 seconds) for effective anticoagulation. INR is used for warfarin monitoring.
A patient with pulmonary embolism (PE) is started on heparin therapy. Which action by the nurse is most appropriate?
A. Monitor INR levels daily
B. Administer the medication IM for faster absorption
C. Monitor the patient for signs of bleeding
D. Encourage ambulation to prevent further clot formation
Correct Answer: C. Monitor the patient for signs of bleeding
Rationale: Bleeding is the most significant complication of heparin therapy. INR is used for warfarin, and heparin is never given IM due to the risk of hematoma formation.
A nurse is teaching a patient with PAD about lifestyle modifications. Which patient statement indicates a need for further teaching?
A. “I should quit smoking to improve circulation.”
B. “I will start a supervised walking program.”
C. “I should soak my feet daily in warm water.”
D. “I need to manage my blood sugar and cholesterol levels.”
Correct Answer: C. “I should soak my feet daily in warm water.”
Rationale: Patients with PAD should avoid soaking their feet as it increases the risk of skin breakdown and infection. Instead, they should keep feet clean, dry, and moisturized (except between the toes).
A patient is receiving warfarin and asks about dietary restrictions. Which food should the nurse advise the patient to consume in consistent amounts?
A. Dairy products
B. Leafy green vegetables
C. Citrus fruits
D. High-fiber grains
Correct Answer: B. Leafy green vegetables
Rationale: Leafy greens are high in vitamin K, which can reduce the effectiveness of warfarin. Patients should maintain a consistent intake, not avoid them entirely.
A nurse is assessing a patient with peripheral artery disease (PAD). Which finding is most consistent with this condition?
A. Brown discoloration around the ankles
B. Warm skin with edema in the affected leg
C. Shiny, hairless skin on the lower extremities
D. Pulses that increase with limb elevation
Correct Answer: C. Shiny, hairless skin on the lower extremities
Rationale: PAD causes poor arterial blood flow, leading to thin, shiny skin, hair loss, and delayed wound healing. Brown discoloration and edema are more indicative of chronic venous insufficiency.
The nurse is teaching a patient with venous insufficiency about preventing complications. Which statement by the patient requires further teaching?
A. “I should wear compression stockings every day.”
B. “I will keep my legs elevated when resting.”
C. “I should cross my legs to improve circulation.”
D. “I will inspect my skin daily for any changes.”
Correct Answer: C. “I should cross my legs to improve circulation.”
Rationale: Crossing the legs impairs venous return, increasing venous stasis and swelling. Patients with venous insufficiency should avoid crossing their legs to promote circulation.
A nurse is reviewing discharge instructions with a patient receiving warfarin. Which statement indicates a need for further education?
A. “I should use an electric razor instead of a regular razor.”
B. “I will avoid taking ibuprofen for pain.”
C. “If I miss a dose, I should take two doses the next day.”
D. “I will have my INR checked regularly.”
Correct Answer: C. “If I miss a dose, I should take two doses the next day.”
Rationale: Warfarin should never be doubled if a dose is missed, as it increases the risk of bleeding complications. Patients should take the next scheduled dose and notify their provider.
A patient with a DVT is prescribed enoxaparin (Lovenox). Which instruction should the nurse provide?
A. “This medication is given orally once a day.”
B. “You will need frequent blood tests to monitor your INR.”
C. “This medication is injected subcutaneously into your abdomen.”
D. “If you miss a dose, take two injections at the next scheduled time.
Correct Answer: C. “This medication is injected subcutaneously into your abdomen.”
Rationale: Enoxaparin (Lovenox) is a low-molecular-weight heparin (LMWH) that is administered subcutaneously in the abdomen. It does not require INR monitoring like warfarin.
A nurse is providing teaching to a patient with chronic venous insufficiency. Which statement indicates that the patient understands the instructions?
A. “I should dangle my legs when sitting to promote circulation.”
B. “I will apply warm compresses to my legs to improve blood flow.”
C. “I should elevate my legs above heart level whenever possible.”
D. “I will wear tight knee-high socks to reduce swelling.”
Correct Answer: C. “I should elevate my legs above heart level whenever possible.”
Rationale: Leg elevation promotes venous return and reduces swelling in venous insufficiency. Warm compresses and dangling the legs can worsen symptoms.
A patient is diagnosed with heparin-induced thrombocytopenia (HIT). Which action should the nurse take first?
A. Administer platelet transfusion
B. Stop the heparin infusion immediately
C. Increase the heparin dose to compensate for low platelets
D. Monitor the INR and aPTT levels
Correct Answer: B. Stop the heparin infusion immediately
Rationale: HIT is a severe immune-mediated reaction that increases clotting risk. Heparin must be discontinued immediately, and an alternative anticoagulant should be used.
A patient is diagnosed with a pulmonary embolism (PE). Which intervention should the nurse prioritize?
A. Apply warm compresses to the affected limb
B. Place the patient in Trendelenburg position
C. Administer oxygen and prepare for anticoagulation therapy
D. Encourage ambulation to prevent further clot formation
Correct Answer: C. Administer oxygen and prepare for anticoagulation therapy
Rationale: Oxygen administration is the priority to manage hypoxia, followed by anticoagulation therapy to prevent clot progression. Trendelenburg position is contraindicated.
A nurse is teaching a patient with PAD about exercise therapy. Which instruction should be included?
A. “Avoid walking if you experience pain in your legs.”
B. “Take frequent breaks and rest as soon as discomfort starts.”
C. “Walk until discomfort occurs, then rest briefly and continue walking.”
D. “Only perform non-weight-bearing exercises like swimming.”
Correct Answer: C. “Walk until discomfort occurs, then rest briefly and continue walking.”
Rationale: Walking until claudication occurs, resting, and continuing promotes collateral circulation and improves PAD symptoms.
A patient with a DVT is being discharged on warfarin therapy. Which symptom should prompt the patient to seek immediate medical attention?
A. Mild bruising at the injection site
B. Occasional headaches
C. Black, tarry stools
D. Slight gum bleeding when brushing teeth
Correct Answer: C. Black, tarry stools
Rationale: Black, tarry stools (melena) indicate gastrointestinal bleeding, a serious side effect of warfarin. The patient should seek immediate medical attention.
A nurse is caring for a patient receiving an intravenous heparin infusion for a DVT. Which laboratory value should be monitored to assess therapeutic effectiveness?
A. INR
B. aPTT
C. D-dimer
D. Platelet count
Correct Answer: B. aPTT
Rationale: aPTT is used to monitor heparin therapy and should be 1.5 to 2.5 times the normal range (about 60–80 seconds). INR is used for warfarin.
A patient with a history of venous thromboembolism (VTE) is planning an overseas flight. Which intervention should the nurse recommend?
A. Take aspirin before the flight to prevent clot formation
B. Wear compression stockings and stay hydrated
C. Avoid movement during the flight to prevent dislodging a clot
D. Keep legs crossed to maintain circulation
Correct Answer: B. Wear compression stockings and stay hydrated
Rationale: Compression stockings and hydration help prevent venous stasis and DVT recurrence. Avoiding movement and crossing legs increases clot risk.
A patient receiving anticoagulation therapy reports sudden onset of severe headache and dizziness. What is the nurse’s priority action?
A. Reassure the patient and offer pain medication
B. Check the patient’s INR level
C. Notify the healthcare provider immediately
D. Encourage the patient to lie down and rest
Correct Answer: C. Notify the healthcare provider immediately
Rationale: Sudden severe headache and dizziness may indicate intracranial bleeding, a medical emergency. The provider must be notified immediately.
