Chapter 37 Vascular Disorders PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter37:VascularDisorders TestBank MULTIPLECHOICE 1.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. DIF:CognitiveLevel:Apply(application)REF:811 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 2.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. DIF:CognitiveLevel:Apply(application)REF:811 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 3.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.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

b.

additionalantibiotic.

c.

decreaseinIVinfusionrate.

d.

bloodureanitrogen(BUN)level.

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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. DIF:CognitiveLevel:Apply(application)REF:814 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 4.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. DIF:CognitiveLevel:Apply(application)REF:805 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 5.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

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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. DIF:CognitiveLevel:Apply(application)REF:808 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 6.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). DIF:CognitiveLevel:Apply(application)REF:803 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 7.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. DIF:CognitiveLevel:Apply(application)REF:804 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 8.Whenevaluatingthedischargeteachingforapatientwithchronicperipheralarterydisease(PAD),thenurse

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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. DIF:CognitiveLevel:Apply(application)REF:806 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 9.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. DIF:CognitiveLevel:Apply(application)REF:810 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 10.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.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

d.

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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. DIF:CognitiveLevel:Apply(application)REF:823 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 11.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. DIF:CognitiveLevel:Apply(application)REF:823 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 12.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

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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. DIF:CognitiveLevel:Apply(application)REF:819 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 13.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. DIF:CognitiveLevel:Apply(application)REF:819 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 14.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. DIF:CognitiveLevel:Apply(application)REF:825 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 15.Whichtopicshouldthenurseincludeinpatientteachingforapatientwithavenousstasisulcerontheleft

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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. DIF:CognitiveLevel:Apply(application)REF:826 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 16.A67-year-oldpatientisadmittedtothehospitalwithadiagnosisofvenousinsufficiency.Whichpatient statementismostsupportiveofthediagnosis? a.

Icantgetmyshoesonattheendoftheday.

b.

Icantseemtoevergetmyfeetwarmenough.

c.

IhaveburninglegpainsafterIwalktwoblocks.

d.

Iwakeupduringthenightbecausemylegshurt.

ANS:A Becausetheedemaassociatedwithvenousinsufficiencyincreaseswhenthepatienthasbeenstanding,shoes willfeeltighterattheendoftheday.Theotherpatientstatementsarecharacteristicofperipheralarterydisease (PAD). DIF:CognitiveLevel:Apply(application)REF:826 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 17.Whichnursingactionshouldbeincludedintheplanofcareafterendovascularrepairofanabdominal aorticaneurysm? a.

Recordhourlychesttubedrainage.

b.

Monitorfluidintakeandurineoutput.

c.

Checktheabdominalincisionforanyredness.

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Teachthereasonforaprolongedrecoveryperiod.

ANS:B 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. DIF:CognitiveLevel:Apply(application)REF:812 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 18.Whichactionbyanursewhoisgivingfondaparinux(Arixtra)toapatientwithalowerlegvenous thromboembolism(VTE)indicatesthatmoreeducationaboutthedrugisneeded? a.

Thenurseavoidsrubbingtheinjectionsiteaftergivingthedrug.

b.

Thenurseinjectsthedrugintotheabdominalsubcutaneoustissue.

c.

Thenurseejectstheairbubbleinthesyringebeforegivingthedrug.

d.

Thenursefailstoassessthepartialthromboplastintime(PTT)beforegivingthedrug.

ANS:C Theairbubbleisnotejectedbeforegivingfondaparinuxtoavoidlossofmedication.Theotheractionsbythe nurseareappropriate. DIF:CognitiveLevel:Apply(application)REF:820 TOP:NursingProcess:ImplementationMSC:NCLEX:SafeandEffectiveCareEnvironment 19.A23-year-oldpatienttellsthehealthcareprovideraboutexperiencingcold,numbfingerswhenrunning duringthewinterandRaynaudsphenomenonissuspected.Thenursewillanticipateteachingthepatientabout testsfor a.

hyperglycemia.

b.

hyperlipidemia.

c.

autoimmunedisorders.

d.

coronaryarterydisease.

ANS:C SecondaryRaynaudsphenomenonmayoccurinconjunctionwithautoimmunediseasessuchasrheumatoid arthritis.Patientsshouldbescreenedforautoimmunedisorders.Raynaudsphenomenonisnotassociatedwith hyperlipidemia,hyperglycemia,orcoronaryarterydisease. DIF:CognitiveLevel:Apply(application)REF:809

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TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 20.Whileworkingintheoutpatientclinic,thenursenotesthatapatienthasahistoryofintermittent claudication.Whichstatementbythepatientwouldsupportthisinformation? a.

WhenIstandtoolong,myfeetstarttoswell.

b.

IgetshortofbreathwhenIclimbalotofstairs.

c.

MyfingershurtwhenIgooutsideincoldweather.

d.

MylegscrampwheneverIwalkmorethanablock.

ANS:D Crampingthatisprecipitatedbyaconsistentlevelofexerciseisdescriptiveofintermittentclaudication.Finger painassociatedwithcoldweatheristypicalofRaynaudsphenomenon.Shortnessofbreaththatoccurswith exerciseisnottypicalofintermittentclaudication,whichisreproducible.Swellingassociatedwithprolonged standingistypicalofvenousdisease. DIF:CognitiveLevel:Apply(application)REF:803 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 21.Whendevelopingateachingplanfora76-year-oldpatientnewlydiagnosedwithperipheralarterydisease (PAD),whichinstructionsshouldthenurseinclude? a.

Exerciseonlyifyoudonotexperienceanypain.

b.

Itisveryimportantthatyoustopsmokingcigarettes.

c.

Trytokeepyourlegselevatedwheneveryouaresitting.

d.

Putelasticcompressionstockingsonearlyinthemorning.

ANS:B SmokingcessationisessentialforslowingtheprogressionofPADtocriticallimbischemiaandreducingthe riskofmyocardialinfarctionanddeath.Circulationtothelegswilldecreaseifthelegsareelevated.Patients withPADaretaughttoexercisetothepointoffeelingpain,rest,andthenresumewalking.Supporthoseare notusedforpatientswithPA...