PRELIMS Practice Tests 4

91. A client with varicose veins is being discharged after treatment. Which instruction should the nurse include to promote venous return? A. Keep the legs dependent for long periods. B. Elevate the feet and legs when resting. C. Avoid walking. D. Sit continuously throughout the day.

B. Elevate the feet and legs when resting — Elevating the legs helps promote venous return and decreases venous pooling and edema.

92. A client with varicose veins is prescribed elastic support stockings. When should the nurse recommend putting them on? A. After standing for several hours B. After the legs become swollen C. Before prolonged standing or activity D. Only while sleeping

C. Before prolonged standing or activity — Support stockings help prevent venous pooling and should be applied before prolonged standing or activity, when the legs are less swollen.

93. A client with varicose veins asks why walking is encouraged. Which response by the nurse is best? A. “Walking helps improve venous return through muscle contraction.” B. “Walking eliminates damaged valves.” C. “Walking immediately removes the varicose veins.” D. “Walking prevents all future vascular disease.”

A. “Walking helps improve venous return through muscle contraction.” — Contraction of the lower-leg muscles helps push venous blood back toward the heart and improves venous return.

94. A nurse is caring for a client following vein surgery. Which assessment is the priority? A. Hair growth B. Distal circulation C. Appetite D. Bowel sounds

B. Distal circulation — After vascular surgery, the nurse should closely assess circulation, including peripheral pulses, skin color, temperature, sensation, and swelling.

95. A client with an abdominal aortic aneurysm is preparing for surgical repair. Which nursing instruction is especially important? A. Encourage vigorous coughing. B. Encourage activities that increase intra-abdominal pressure. C. Teach deep-breathing exercises while avoiding coughing. D. Encourage heavy lifting.

C. Teach deep-breathing exercises while avoiding coughing. — Deep breathing is encouraged, but coughing should be avoided because it increases intra-abdominal pressure and tension at the surgical site.

96. A client recovering from abdominal aortic aneurysm repair asks why heavy lifting should be avoided. What is the best response? A. It may increase intra-abdominal pressure. B. It decreases blood glucose. C. It causes venous valves to close. D. It improves arterial circulation too quickly.

A. It may increase intra-abdominal pressure. — Increased intra-abdominal pressure can place stress on the surgical area and should therefore be avoided after AAA repair.

97. A nurse is assessing a client with an abdominal aortic aneurysm. Which assessment is particularly important? A. Peripheral pulses B. Pupil size C. Bowel frequency only D. Hearing acuity

A. Peripheral pulses — Peripheral pulses help the nurse assess tissue perfusion and detect changes in circulation.

98. A client with peripheral arterial disease has pale skin when the leg is elevated. What does this finding suggest? A. Normal venous circulation B. Arterial insufficiency C. Improved arterial flow D. Normal tissue perfusion

B. Arterial insufficiency — Pallor when the extremity is elevated is a characteristic finding associated with decreased arterial blood flow.

99. A nurse assesses a client with suspected arterial disease. Which skin finding would support the diagnosis? A. Warm, moist skin with normal hair growth B. Dry, scaly skin with hair loss C. Soft, pink skin with increased circulation D. Generalized flushing only

B. Dry, scaly skin with hair loss — Arterial insufficiency can cause hair loss, dry or scaly skin, pallor, mottling, and a cold extremity.

100. A client with peripheral arterial disease develops an ulcer between the toes. The nurse notes thickened toenails and poor peripheral pulses. Which type of ulcer is most likely? A. Arterial ulcer B. Venous ulcer C. Pressure ulcer D. Surgical ulcer

A. Arterial ulcer — Arterial ulcers commonly occur at the ends or between the toes and are associated with poor peripheral pulses and thickened toenails.

101. A client has an ulcer near the ankle with skin discoloration, but peripheral pulses are normal. Which type of ulcer should the nurse suspect? A. Arterial ulcer B. Venous ulcer C. Diabetic foot ulcer D. Traumatic ulcer

B. Venous ulcer — Venous ulcers commonly occur around the ankle and may be associated with skin discoloration while peripheral pulses remain normal.

102. A nurse observes a foul-smelling discharge coming from a client’s foot ulcer. Which type of ulcer is this finding most associated with? A. Arterial ulcer B. Venous ulcer C. Diabetic ulcer D. Varicose ulcer

C. Diabetic ulcer — Foul-smelling discharge is a characteristic finding associated with diabetic ulcers.

103. A client with peripheral arterial disease asks why the legs should not be elevated above heart level. Which response is best? A. “It can slow arterial blood flow to the extremities.” B. “It causes excessive venous return.” C. “It increases oxygen delivery.” D. “It eliminates claudication.”

A. “It can slow arterial blood flow to the extremities.” — Elevating the legs above heart level can further decrease arterial blood flow to an ischemic extremity.

104. A client with severe peripheral arterial disease reports significant rest pain. Which position may help improve comfort and circulation? A. Affected leg elevated well above the heart B. Affected limb hanging down C. Both legs tightly crossed D. Legs elevated for the entire night

B. Affected limb hanging down — In severe arterial disease with rest pain, allowing the affected limb to hang down can promote arterial blood flow through gravity.

105. A client with suspected peripheral arterial disease is scheduled for an ankle-brachial index (ABI). What is the purpose of this test? A. To determine the degree of arterial circulation impairment B. To measure lung capacity C. To identify cardiac valve disease D. To diagnose anemia

A. To determine the degree of arterial circulation impairment — ABI compares ankle systolic blood pressure with brachial systolic blood pressure and helps identify peripheral arterial disease.

106. A client has an ABI of 0.72. How should the nurse interpret this result? A. Normal arterial circulation B. Diagnostic of peripheral arterial disease C. Excessive venous circulation D. Normal result for severe PAD

B. Diagnostic of peripheral arterial disease — An ABI below 0.9 is considered diagnostic of peripheral arterial disease.

107. A client with intermittent claudication asks why pain occurs after walking a certain distance. What is the best explanation? A. The muscles require more oxygen than the narrowed arteries can supply. B. The veins suddenly become completely blocked. C. The heart stops pumping during exercise. D. The muscles receive excessive oxygen.

A. The muscles require more oxygen than the narrowed arteries can supply. — Peripheral arterial obstruction limits oxygen delivery. During activity, the muscles require more oxygen, producing reproducible cramping or burning pain.

108. A client with peripheral arterial disease asks what factors can worsen vasoconstriction. Which combination should the nurse identify? A. Warmth and walking B. Nicotine, caffeine, and emotional stress C. Hydration and exercise D. Leg elevation and rest

B. Nicotine, caffeine, and emotional stress — Nicotine, caffeine, and emotional stress can promote vasoconstriction and worsen peripheral arterial circulation.

109. A client with peripheral arterial disease is scheduled for arteriography. Which complication should the nurse monitor for after the procedure? A. Hemorrhage B. Increased hair growth C. Improved circulation only D. Increased appetite

A. Hemorrhage — Arteriography is invasive and can result in complications such as hemorrhage, thrombosis, embolus, and, rarely, death.

110. A client with DVT is placed on bed rest. Which additional intervention should the nurse anticipate? A. Elevation of the affected extremity B. Vigorous massage of the affected leg C. Tight compression directly over the clot D. Continuous dangling of the leg

A. Elevation of the affected extremity — Initial management of DVT may include rest and elevation. The affected extremity should not be massaged because the clot could dislodge.

111. A client with DVT suddenly develops shortness of breath, chest pain, and rapid breathing. Which complication should the nurse suspect? A. Varicose veins B. Pulmonary embolism C. Raynaud disease D. Stable angina

B. Pulmonary embolism — A DVT can dislodge and travel to the lungs, causing a pulmonary embolism. Sudden respiratory symptoms and chest pain require immediate attention.

112. A client is taking warfarin after a DVT. Which teaching is most appropriate? A. “You should participate in contact sports.” B. “Report unusual bleeding or bruising.” C. “Stop the medication whenever your leg feels better.” D. “Take aspirin routinely without discussing it with your provider.”

B. “Report unusual bleeding or bruising.” — Warfarin increases bleeding risk. The client should monitor for and report unusual bleeding, bruising, or other signs of excessive anticoagulation.

113. A client taking anticoagulants asks why contact sports should be avoided. What is the best response? A. “They can increase your risk for traumatic bleeding.” B. “They prevent the medication from working.” C. “They increase your red blood cell count.” D. “They cause venous valves to become incompetent.”

A. “They can increase your risk for traumatic bleeding.” — Anticoagulation increases bleeding risk, so activities with a high likelihood of injury should be avoided.

114. A nurse is assessing a client with suspected DVT. Which combination of findings is most concerning? A. Bilateral ankle swelling after standing B. Sudden unilateral leg swelling and calf pain C. Pale fingers after cold exposure D. Tortuous veins relieved by elevation

B. Sudden unilateral leg swelling and calf pain — Sudden unilateral swelling with calf or groin pain is characteristic of DVT.

115. A nurse is caring for a client with suspected DVT. Which assessment technique should the nurse avoid relying on because it has low diagnostic value? A. Duplex ultrasound B. Doppler flow study C. Homan sign D. Contrast venography

C. Homan sign — Homan sign is not recommended as a reliable diagnostic assessment because it has poor sensitivity and specificity.

116. A client with DVT asks about the main goals of treatment. Which response is correct? A. “Treatment prevents pulmonary embolism and further clot formation or enlargement.” B. “Treatment permanently removes all venous valves.” C. “Treatment increases platelet aggregation.” D. “Treatment intentionally enlarges the clot.”

A. “Treatment prevents pulmonary embolism and further clot formation or enlargement.” — Management of DVT focuses on preventing pulmonary embolism, preventing additional clot formation, and preventing enlargement of the existing thrombus.

117. A client with varicose veins has been standing at work for many hours each day. Which recommendation is most appropriate? A. Avoid all movement. B. Alternate periods of activity and rest and avoid prolonged standing. C. Keep the legs dependent continuously. D. Cross the legs while standing.

B. Alternate periods of activity and rest and avoid prolonged standing. — Prolonged standing contributes to venous pooling. Walking and avoiding prolonged standing or sitting can improve venous return.

118. A client is scheduled for vein stripping because of severe varicose veins. The nurse explains that the procedure involves

A. Removing the dysfunctional vein after ligation B. Inflating a balloon inside the vein C. Dissolving the vein with medication D. Increasing venous pressure

119. A client with varicose veins undergoes surgery. Which nursing intervention should be included in postoperative care? A. Assess the dressing for active bleeding. B. Keep the legs completely immobile. C. Discourage ambulation. D. Keep the affected leg dependent continuously.

A. Assess the dressing for active bleeding. — After vascular surgery, the nurse should monitor the dressing for bleeding and assess circulation, swelling, and other postoperative complications. Ambulation may be encouraged as appropriate.

120. A nurse is reviewing the major differences between arterial and venous disorders with a client. Which statement indicates correct understanding? A. “Arterial disease is usually improved by keeping my legs elevated above my heart.” B. “Venous problems can improve with elevation and walking.” C. “I should massage my leg if I suspect a DVT.” D. “Smoking improves blood flow in Buerger disease.”

B. “Venous problems can improve with elevation and walking.” — Elevation and walking promote venous return and can help with venous disorders. In contrast, elevation above heart level can worsen arterial insufficiency, a suspected DVT should never be massaged, and smoking cessation is essential in Buerger disease.