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Chapter 31- Assessment and Management of Patients With Vascular Disorders

1. A patient reports experiencing pain in the left lower leg and foot when walking. The nurse notes that the leg is slightly edematous and is hairless. This pain is relieved with rest. The nurse suspects that the patient may be experiencing: A) Coronary artery disease C) Arterial embolus B) Intermittent claudication D) Raynaud's disease Ans: B Difficulty: Moderate 2. The nurse who notes that the patient's ankle-brachial index (ABI) of the right leg is 0.40 is aware that this may indicate: A) Venous narrowing C) Adequate peripheral circulation B) Arterial narrowing D) Inadequate coronary output Ans: B Difficulty: Difficult 3. The most appropriate goal for a patient with peripheral arterial insufficiency is promotion of: A) Vasoconstriction C) Vascular compression B) Vasodilatation D) Atherosclerosis Ans: B Difficulty: Moderate 4. To maintain adequate tissue integrity to the lower legs of a patient with peripheral vascular disease, the nurse should encourage the patient to: A) Use strong soaps to clean the feet. C) Eat a low-protein diet. B) Avoid trimming toenails. D) Wear sturdy, well-fitting shoes. Ans: D Difficulty: Moderate 5. When assessing a patient with peripheral arterial occlusive disease (PAOD) of the left leg, the nurse expects to find: A) Equal pulses in the extremities C) Equal skin color between extremities B) Unequal pulses between extremities D) Warm feet between extremities Ans: B Difficulty: Moderate 6. A patient has undergone a femoral to popliteal bypass graft surgery. The nurse must assess which of the following during the first postoperative day? A) Assess pulse of affected extremity every hour. B) Assess pulse of affected extremity every shift. C) Ensure the patient is crossing the legs. D) Perform Doppler evaluation every 4 hours. Ans: A Difficulty: Moderate
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7. The nurse is preparing the patient for surgery to correct the arterial occlusive disease the patient has in the right arm. The nurse should: A) Keep the patient's right arm at heart level. B) Initiate an IV in the right arm. C) Apply cool compresses to the right arm. D) Apply a tensor to the right arm. Ans: A Difficulty: Moderate 8. A patient informs the nurse that he feels his heart beating in his abdomen while lying down and feels a large lump when pressing on his abdomen. The nurse suspects the patient may have: A) A deep vein thrombosis C) Raynaud's disease B) A thoracic aortic aneurysm D) An abdominal aortic aneurysm Ans: D Difficulty: Moderate 9. A patient is diagnosed with Raynaud's disease. The nurse is aware that this disease is characterized by: A) Venous thrombosis C) Arterial vasodilatation B) Arteriolar vasoconstriction D) Intermittent claudication Ans: B Difficulty: Moderate 10. A 32-year-old woman who takes oral contraceptives is to undergo surgery and as a result will be on bed rest for 48 hours. The patient may be at an increased risk of developing: A) Deep vein thrombosis C) Raynaud's disease B) Intermittent claudication D) Thoracic aneurysm Ans: A Difficulty: Moderate 11. A patient at risk of developing deep vein thrombosis has been prescribed warfarin sodium (Coumadin) to be taken daily. The patient also complains of occasional pain to the legs. The nurse should instruct the patient to: A) Monitor blood pressure weekly. B) Observe for signs and symptoms of infection. C) Report for regular blood studies of international normalized ratio (INR) levels. D) Use aspirin for the pain. Ans: C Difficulty: Moderate 12. The nurse is instructing the patient on measures to take to prevent complications from venous insufficiency. One such measure will include: A) Avoiding tight-fitting socks C) Sleeping with legs dependent B) Reducing activity D) Avoiding pressure stockings

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Ans: A Difficulty: Moderate 13. The nurse notes a small, circular, deep, reddened ulcer on the tip of the patient's great toe. The patient states it is extremely painful, even at rest. The nurse suspects this may be: A) A venous ulcer C) Gangrene of the toe B) An arterial ulcer D) Venous stasis Ans: B Difficulty: Moderate 14. The most appropriate dressing to apply on a patient with a superficial, uninfected leg ulcer would be a: A) Hydrocolloid dressing C) Dry sterile dressing B) Dry gauze dressing D) Hydrogen peroxide dressing Ans: A Difficulty: Moderate 15. When implementing steps to restore skin integrity for a patient with leg ulcers, the nurse should include: A) Cleansing the skin with alcohol C) Applying heating pads to the legs B) Using a bed cradle D) Avoiding footwear when ambulating Ans: B Difficulty: Moderate 16. A patient with lymphangitis is experiencing lymphedema. The nurse is aware that the lymphedema may be due to: A) Obstructed lymph vessels C) Accumulation of blood B) Sensitivity to antibiotics D) Improper anticoagulant use Ans: A Difficulty: Moderate 17. The nurse caring for a patient who is taking an anticoagulant should teach him to: A) Report incidents of diarrhea. C) Use a straight razor when shaving. B) Avoid foods high in vitamin K. D) Take aspirin for pain relief. Ans: B Difficulty: Moderate 18. The nurse instructing a patient about the use of antiembolism stockings is aware that they help prevent deep vein thrombosis (DVT) by: A) Encouraging ambulation to prevent pooling of blood B) Providing warmth to the extremity C) Elevating the extremity to prevent pooling of blood D) Forcing blood into the deep venous system Ans: D

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Difficulty: Moderate 19. A 57-year-old patient reports experiencing leg pain whenever he walks several blocks. The patient has type 1 diabetes and has smoked two packs of cigarettes per day for the past 40 years. The physician diagnoses intermittent claudication. The nurse should provide which instruction about long-term care? A) Practice meticulous foot care. B) Consider cutting down on your smoking. C) Reduce your exercise level. D) See the physician if the symptoms bother you. Ans: A Difficulty: Moderate 20. What intervention should the nurse caring for a postoperative patient perform to prevent thrombophlebitis? A) Encourage the patient to perform coughing and deep-breathing exercises. B) Apply compression stockings. C) Massage the legs gently. D) Encourage the patient to turn frequently. Ans: B Difficulty: Moderate 21. The nurse is administering warfarin (Coumadin) to a patient with deep vein thrombophlebitis. Which laboratory value indicates warfarin is at therapeutic levels? A) Partial thromboplastin time (PTT) 1 to 2 times the control B) Prothrombin time (PT) 1 to 2 times the control C) International normalized ratio (INR) of 3 to 4 D) Hematocrit of 32% Ans: B Difficulty: Difficult 22. A patient, age 54, is admitted with a diagnosis of venous ulceration unresponsive to treatment. Which of the following is the nurse most likely to find during an assessment of a patient with venous ulceration? A) Gangrene B) Heavy exudate C) Deep wound bed D) Pale wound bed Ans: B Difficulty: Moderate 23. A nurse in the rehabilitation unit is caring for a 72-year-old patient who is in cardiac rehabilitation following a myocardial infarction. The nurse's plan of care calls for the patient to walk for 15 minutes three times a day. The patient asks why walking is good for his heart. The nurse's best response is: A) The arteries in your legs constrict when you walk and allow the blood to move faster and with more pressure on the tissue. B) Walking decreases the heart's pumping ability and increases your heart rate and blood pressure; therefore your heart in under less stress.

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C) D)

Walking helps your heart adjust to your new arteries and provides a way to have fun. When you walk, the muscles in your legs contract and pump the blood in your veins back toward your heart, which allows more blood to return to your heart. Ans: D Difficulty: Moderate

24. A nurse is caring for a 72-year-old patient who is in cardiac rehabilitation following open-heart surgery. He has been walking for 15 minutes three times a day for about 1 week. The patient informs the nurse that he is having a cramp-like pain in his legs every time he walks and that the pain gets better when he rests. The nurse suspects: A) Glomerular nephritis C) Venous insufficiency B) Intermittent claudication D) Vasculitis Ans: B Difficulty: Moderate 25. A nurse is caring for a 54-year-old man with peripheral arterial insufficiency with a nursing diagnosis of altered peripheral tissue perfusion related to compromised circulation. The most appropriate intervention for this diagnosis would be: A) Elevate his legs and arms above his heart when resting. B) Encourage the patient to engage in a moderate amount of exercise. C) Encourage long periods of sitting or standing. D) Discourage walking to decrease pain. Ans: B Difficulty: Moderate 26. A nurse is admitting a 45-year-old man to the medical-surgical unit who has been diagnosed with Buerger's disease. During his health history, he reveals that he smokes about 2 packs of cigarettes a day, has a history of alcohol abuse, and does not exercise. The priority teaching for this patient would focus on: A) The lack of exercise, which is the identified cause of Buerger's disease B) The likelihood that drinking alcohol and not exercising may cause his death in the near future without a significant change in behavior C) The fact that smoke contains nicotine, which is a powerful vasoconstrictor and may cause or aggravate Buerger's disease D) The fact that alcohol suppresses the immune system, creates high glucose levels, and may cause Buerger's disease Ans: C Difficulty: Moderate 27. A nurse is caring for an 83-year-old woman in a long-term-care facility who has a history of heart failure and peripheral arterial disease. The patient is unable to stand or ambulate. The nurse knows this places the patient at significant risk for: A) Aoritis C) Thoracic aortic aneurysm B) Deep vein thrombosis D) Raynaud's disease Ans: B

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Difficulty: Difficult 28. A nurse in a primary care clinic is working with a 57-year-old man with type 2 diabetes who has leg ulcerations that are weeping and open. He also has vascular insufficiency as a new medical diagnosis. The most appropriate nursing diagnosis would be: A) Impaired physical mobility related to activity restrictions of the therapeutic regimen and pain B) Impaired skin integrity related to compromised circulation C) Altered tissue perfusion related to diabetes D) Imbalanced nutrition, less than body requirements, related to increased need for nutrients that promote wound healing Ans: B Difficulty: Moderate 29. When there is an inadequate supply of oxygen to the tissues in a person's legs, leg ulcers may develop. Which of the following is the primary goal for the nursing diagnosis of impaired skin integrity related to vascular insufficiency? A) Anxiety reduction C) Avoidance of vascular stimulation B) Restoration of skin integrity D) Improved physical mobility Ans: B Difficulty: Moderate 30. A patient with a history of chronic venous insufficiency is being seen in the emergency department complaining of pain and swelling in his right lower leg that began the previous night, along with fever, chills, and sweating. The patient states that she hit her leg on the car door 4 or 5 days ago and it has been sore ever since. The nurse suspects that this might be: A) Thrombocytopenia C) Cellulitis B) Arterial insufficiency D) Phlebothrombosis Ans: C Difficulty: Moderate 31. A patient presents in immediate care complaining of pain in his foot after stepping on a roofing nail a couple of days ago. He is worried because he has a red streak running up his leg. The nurse suspects: A) Cellulitis C) Elephantiasis B) A minor superficial skin irritation D) Lymphangitis Ans: D Difficulty: Moderate 32. The nurse who is aware that varicose veins are abnormally dilated vessels due to incompetent valves suggests which of the following proactive preventative nursing interventions: A) Sitting with crossed legs to promote relaxation B) Walking for several minutes every hour to promote circulation C) Elevating the legs when tired

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D)

Wearing tight ankle socks to decrease edema Ans: B Difficulty: Moderate

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