Question 1

A 72-year-old patient is hospitalized for an aortic dissection of the abdominal aorta that stabilizes with treatment. The nurse develops a teaching plan for the patient's discharge that includes information about

Accepted Answer

A)   gradually increasing exercise to improve cardiac function and BP control.
B)   appropriate use of nonsteroidal antiinflammatory agents (NSAIDs)  to control any abdominal pain.
C)   holding prescribed b-blockers if dizziness or weakness occur to avoid injury.
D)   the use of antihypertensive medications to lower the risk of further dissection or bleeding. D

Question 2

A nursing action that is indicated for the collaborative problem of potential complication: cardiac dysrhythmia in a patient who has had a repair of a descending thoracic aortic aneurysm is to

Accepted Answer

A)   assess level of consciousness and orientation hourly.
B)   titrate oxygen to keep O2 saturation greater than 90%.
C)   turn the patient every 1 to 2 hours while on bed rest.
D)   monitor hourly fluid intake and urine output levels. B

Question 3

A 69-year old patient is admitted to the hospital for elective repair of an abdominal aortic aneurysm. The history includes hypertension for 25 years, hyperlipidemia for 15 years, and smoking for 50 years. The patient asks the nurse what caused the aneurysm. The nurse's best response includes the information that

Accepted Answer

A)   congenital weakness of arterial walls eventually results in an aneurysm.
B)   atherosclerotic plaques damage the artery and may lead to aneurysms.
C)   chronic infections of blood vessel walls may have contributed to the aneurysm.
D)   uncontrolled hypertension, hyperlipidemia, and smoking caused the aneurysm. B

Question 4

When the nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair, the information that is most significant when the nurse is assessing for the return of peristalsis is

Accepted Answer

A)   absence of abdominal distention.
B)   passing of flatus with ambulation.
C)   dark brown nasogastric (NG)  tube drainage.
D)   moderate abdominal tenderness.

Question 5

While working in the outpatient clinic, the nurse notes that the chart states that a patient has intermittent claudication. Which of these statements by the patient would be consistent with this information?

Accepted Answer

A)   "My fingers hurt when I go outside in cold weather."
B)   "Sometimes I get tired when I climb a lot of stairs."
C)   "When I stand too long, my feet start to swell up."
D)   "My legs cramp whenever I walk more than a block."

Question 6

When assessing a patient with possible PAD, the nurse obtains a brachial BP of 140/80 and an ankle pressure of 110/70. The nurse calculates the patient's ankle-brachial index (ABI) as ______.

Accepted Answer

The answer of When assessing a patient with possible PAD,...

Question 7

A 36-year-old patient who has a history of thromboangiitis obliterans (Buerger's disease) is admitted to the hospital with a gangrenous lesion of the right small toe. When the nurse is planning expected outcomes for the patient, which outcome has the highest priority for this patient?

Accepted Answer

A)   Cessation of smoking
B)   Maintenance of appropriate weight
C)   Control of serum lipid levels
D)   Demonstration of meticulous foot care

Question 8

Which of these nursing actions in the care plan for a patient who had a repair of an abdominal aortic aneurysm 5 days previously is most appropriate for the nurse to delegate to an experienced nursing assistant?

Accepted Answer

A)   Teach the patient the signs of possible wound infection.
B)   Monitor the quality and presence of the pedal pulses.
C)   Assist the patient in using a pillow to splint while coughing.
D)   Check the lower extremity strength and movement.

Question 9

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which behavior by the patient indicates that the teaching has been effective?

Accepted Answer

A)   The patient places the hands in hot water when they turn pale.
B)   The patient exercises indoors during the winter months.
C)   The patient takes pseudoephedrine (Sudafed)  for cold symptoms.
D)   The patient avoids the use of aspirin and the NSAIDs.

Question 10

The nurse identifies a nursing diagnosis of risk for altered peripheral tissue perfusion related to bypass graft thrombosis for a patient following an abdominal aneurysm repair. An appropriate intervention to prevent this problem in the immediate postoperative period is to

Accepted Answer

A)   use a cooling blanket to maintain the patient's temperature within a normal range to prevent hypercoagulability.
B)   place the patient in Trendelenburg position to reduce pressure at the suture line and prevent leaking of blood at the site.
C)   administer IV fluids at a rate to keep the arterial BP within a normal range.
D)   perform passive range-of-motion (ROM)  exercises to the legs hourly to promote venous return.

Question 11

The nurse has initiated discharge teaching for a patient who is to be maintained on warfarin (Coumadin) following hospitalization for DVT. The nurse determines that additional teaching is needed when the patient says,

Accepted Answer

A)   "I should wear a Medic Alert bracelet to indicate I am on anticoagulant therapy."
B)   "I should change my diet to include more green, leafy vegetables."
C)   "I will check with my health care provider before I begin or stop any medication."
D)   "I will need to have blood tests routinely to monitor the effects of the Coumadin."

Question 12

The nurse has identified the collaborative problem of potential complication: pulmonary embolism for a patient with left-calf DVT. Which nursing action is appropriate to include in the plan of care?

Accepted Answer

A)   Maintain bed rest as ordered.
B)   Administer oxygen to keep O2 saturation >90%.
C)   Apply compression gradient stockings.
D)   Remind the patient to dorsiflex the feet and rotate the ankles.

Question 13

The health care provider orders a continuous IV heparin infusion for a patient with swelling and pain of the upper leg caused by a DVT. While the patient is receiving the heparin infusion, the nurse should

Accepted Answer

A)   avoid any IM medications to prevent localized bleeding.
B)   notify the health care provider if the partial thromboplastin time (PTT)  value is greater than 50 seconds.
C)   have vitamin K available in case reversal of the heparin is needed.
D)   monitor posterior tibial and dorsalis pedis pulses with the Doppler.

Question 14

The nurse identifies the nursing diagnosis of ineffective peripheral perfusion related to decreased arterial blood flow for a patient with chronic PAD. In evaluating the patient outcomes following patient teaching, the nurse determines a need for further instruction when the patient says,

Accepted Answer

A)   "I will have to buy some loose clothing that does not bind across my legs or waist."
B)   "I will change my position every hour and avoid long periods of sitting with my legs down."
C)   "I will use a heating pad on my feet at night to increase the circulation and warmth in my feet."
D)   "I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily."

Question 15

When developing a teaching plan for a patient newly diagnosed with PAD, which information should the nurse include?

Accepted Answer

A)   "Try to keep your legs elevated whenever you are sitting."
B)   "Exercise only if you do not experience pain."
C)   "It is important to try to stop smoking."
D)   "Put on support hose early in the day before swelling occurs."

Question 16

A patient with a DVT is started on IV heparin and oral warfarin (Coumadin). The patient asks the nurse why two medications are necessary. The nurse's best response to the patient is,

Accepted Answer

A)   "Heparin will start to dissolve the clot, and Coumadin will prevent any more clots from occurring."
B)   "Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant."
C)   "The heparin will work immediately, but the Coumadin takes several days to have an effect on coagulation."
D)   "Administration of two anticoagulants reduces the risk for recurrent deep vein thrombosis."

Question 17

A patient admitted to the hospital with DVT has health care provider's orders for bed rest with the feet elevated. The best method for the nurse to use in elevating the patient's feet is to

Accepted Answer

A)   place two pillows under the calf of the affected leg.
B)   place the patient in the Trendelenburg position.
C)   elevate the bed at the knee and put pillows under the feet.
D)   put one pillow under the thighs and two pillows under the lower legs.

Question 18

Which statement by a patient who is being discharged 5 days after an abdominal aortic aneurysm repair and graft indicates that the discharge teaching has been effective?

Accepted Answer

A)   "I will call the doctor if my temperature is higher than 101° F."
B)   "I will tell my dentist about this surgery the next time I have an appointment."
C)   "I should not need to take anything but acetaminophen (Tylenol)  for my pain."
D)   "I am eager to get home so that I can pick up my 6-year-old granddaughter."

Question 19

A patient with a history of a 4-cm abdominal aortic aneurysm is admitted to the emergency department with severe back pain and bilateral flank ecchymoses. The vital signs are blood pressure (BP) 90/58, pulse 138, and respirations 34. The nurse plans interventions for the patient based on the expectation that treatment will include

Accepted Answer

A)   immediate surgery.
B)   a STAT angiogram.
C)   a paracentesis when vital signs are stabilized with fluid replacement.
D)   admission to intensive care for observation and diagnostic testing.

Question 20

A patient who is seen in the clinic tells the health care provider about experiencing cold, numb fingers when running during the winter and is diagnosed with Raynaud's phenomenon. The nurse will anticipate teaching the patient about tests for

Accepted Answer

A)   coronary artery disease.
B)   familial hyperlipidemia.
C)   high BP.
D)   immune disorders.

Exam 38: Nursing Management: Vascular Disorders