Lewis Study Guide Chapter 41 - Vascular Disorders

When obtaining a health history from a 72 year old man with peripheral arterial disease PAD of the lower extremities the nurse asks about a history of related conditions, including

A. Venous Thrombosis

B. venous stasis ulcers

C. pulmonary embolism

D. coronary artery disease (CAD)

D

coronary artery disease CAD -- regardless of the location, atherosclerosis is responsible for PAD and is related to other cardiovascular disease and its risk factors such as CAD

Following teaching about medications for PAD, the nurse determines that additional instruction is necessary when the patient makes which statement?

A. "I should take one aspirin a day to prevent clotting in my legs."

B. "The lisinopril I use for my blood pressure may help me walk further without pain."

C. "I will need to have frequent blood tests to evaluate the effect of the Coumadin I will be taking."

D. "Pletal should help me increase my walking distance and help prevent clots from forming in my legs."

C

I will need to have frequent blood tests to evaluate the effect of the Coumadin I will be taking.

oral anticoagulants are not recommended for treatment of PAD but all of the other statements are correct in relation to treatment of PAD

A patient with PAD has a nursing diagnosis of ineffective peripheral tissue perfusion. What should be included in the teaching plan for this patient? (select all that apply)

A. keep legs and feet warm.

B. apply cold compresses when the legs become swollen.

C. walk at least 30 minutes per day to the point of discomfort

D. use nicotine replacement therapy as a substitute for smoking

E. inspect lower extremities for pulses, temperature and any injury

A, C, E

warm legs and feet increase circulation. lower extremities should be assessed at regular intervals for changes. walking exercise increases oxygen extraction in the legs and improves skeletal muscle metabolism

When teaching the patient with PAD about modifying risk factors associated with the condition, what should the nurse emphasize?

A. amputation is the ultimate outcome if the patient does not alter lifestyle behaviors

B. modifications will reduce the risk of other atherosclerotic conditions such as stroke.

C. risk reducing behaviors initiated after angioplasty can stop the progression of the disease.

D.. maintenance of normal body weight is the most important factor in controlling arterial disease

B

Modifications will reduce the risk of other atherosclerotic conditions such as stroke.

PAD occurs as a result of atherosclerosis and the risk factors are the same as for other diseases associated with atheroclerosis such as CAD, CVA, and aneurysms.

During care of the patient following femoral bypass graft surgery, the nurse immediately notifies the health care provider if the patient experiences

A. fever and redness a the incision site

B. 2+ edema of the extremity and pain at the incision site.

C. a loss of palpable pulses and numbness and tingling of the feet

D. increasing ankle brachial indices and serous drainage from the incision

C

a loss of palpable pulses and numbness and tingling of the feet indicate occlusion of the bypass graft and need immediate medical attention.

Which conditions characterize critical limb ishemia? (select all that apply)

A. cold feet

B. arterial leg ulcers

C. venous leg ulcers

D. gangrene of the leg

E. no palpable peripheral pulses

F. rest pain lasting more than 2 weeks

B, D, F

Arterial leg ulcers.

Gangrene of the leg.

Rest pain lasting more than 2 weeks.

What are characteristic of arteriospastic disease (Raynaud's phenomenon)? (select all that apply)

A. predominant in young females

B. may be associated with autoimmune disorders

C. precipitated by exposure to cold caffeine and tobacco

D. involves small cutaneous arteries of the fingers and toes

E. inflammation of small and medium sized arteries and veins

F. Episodes involve white, blue and red color changes of fingertips

A,B,C,D,F

Predominant in young females.

May be associated with autoimmune disorders.

Precipitated by exposure to cold, caffeine, and tobacco.

Involves small cutaneous arteries of the fingers and toes.

Episodes involve white, blue, and red color changes of fingertips.

Which observation made by the nurse should indicate the presence of the complication of graft thrombosis after aortic aneurysm repair?

A. Cardiac dysrhythmias or chest pain

B. absent bowel sounds, abdominal distention or diarrhea

C. increased temperature and increased WBC count

D. decreased pulses and cool painful extremities below the level of repair

D

Decreased pulses and cool, painful extremities below the level of repair indicate graft thrombosis.

What are characteristics of arterial disease? (select all that apply)

A. Pruritus

B. thickened brittle nails

C. dull ache in calf or thigh

D. decreased peripheral pulses

E. pallor on elevation of the legs

F. ulcers over bony prominences on toes and feet

B, D, E, F

Thickened, brittle nails.

Decreased peripheral pulses.

Pallor on elevation of the legs.

Ulcers over bony prominences on toes and feet.

The patient is diagnosed with a superficial vein thrombosis (STV). Which characteristic should the nurse know about SVT?

A. embolization to lungs may result in death

B. clot may extend to deeper veins if untreated

C. vein is tender to pressure and there is edema

D. typically found in the iliac, inferior, or superior vena cava

B

Clot may extend to deeper veins if untreated.

if left untreated a superficial vein thrombosis may extend to deeper veins and VTE may occur. VTE may embolize to the lungs and have tenderness upon pressure and edema.

The surgery area calls the transfer report for a 68 year old, postmenopausal, female patient who smokes and takes hormone therapy. She is returning to the floor after a lengthy hip replacement surgery. Which factors present in this patient increase her risk for developing venous thromboembolism (VTE) related to Virchow's triad? (select all that apply)

A. smoking

B. IV therapy

C. dehydration

D. estrogen therapy

E. orthopedic surgery

F. prolonged immobilization

A, B, D, E, F

Smoking

IV therapy

Estrogen therapy

Orthopedic surgery

Prolonged immobilization

The patient is admitted with pain, edema, and warm skin on her lower left leg. What test should the nurse expect to be ordered first?

A. duplex ultrasound

B. complete blood count

C. MRI

D. computed venography (phlebogram)

A

Duplex ultrasound.

with manifestations of a VTE, the D dimer is drawn to determine if a VTE exists and the duplex ultrasound is most widely used to diagnose VTE by identifying where a thrombus is located and its extent.

The nursing care area is very busy with new surgical patients. Which care could the RN delegate to the unlicensed assistive personnel (UAP) for a patient with VTE?

A. assess the patient's use of herbs.

B. measure the patient for elastic compression stockings

C. remind the patient to flex and extend the legs and feet every 2 hours

D. teach the patient to call emergency medical services with signs of pulmonary embolus

C

Remind the patient to flex and extend the legs and feet every 2 hours.

To help prevent embolization of the thrombus in a patient with a VTE, what should the nurse teach the patient to do?

A. dangle the feet over the edge of the bed q2-3 hours

B. ambulate around the bed three to four times a day

C. keep the affected leg elevated above the level of the heart

D. maintain bed rest until edema is relieved and anticoagulation is established

D

Maintain bed rest until edema is relieved and anticoagulation is established.

Which indirect thrombin inhibitor is only administered subcutaneously and does not need routine coagulation tests?

A. warafarin

B. unfractionated heparin

C. hirudin derivatives

D. low molecular weight heparin

D

Low molecular weight heparin is only given subutaneously and does not require routine coagulation tests

Which characteristics describe the anticoagulant warfarin. (select all that apply)

A. vitamin K is the antidote

B. protamine sulfate is the antidote

C. may be administered orally or subcutaneously

D. may be administered intravenously or subcutaneously

E. dosage monitored using international normalized ratio

F. dosage monitored using activated partial thromboplastin time

A, E

Vitamin K is the antidote.

Dosage monitored using international normalized

ratio (INR).

The patient with VTE is receiving therapy with heparin and asks the nurse whether the drug will dissolve the clot in her leg. What is the best response by the nurse.

A. "this drug will break up and dissolve the clot so that circulation in the vein can be restored."

B. "the purpose of the heparin is to prevent growth of the clot or formation of new clots where the circulation is slowed."

C. "Heparin won't dissolve the clot but it will inhibit the inflammation around the clot and delay the development of new clots."

D. " the heparin will dilate the vein, preventing turbulence of blood flow around the clot that may cause it to break off and travel to the lungs."

B

The purpose of the heparin is to prevent growth of the clot or formation of new clots where the circulation is slowed.

A patient with VTE is to be discharged on long term warfarin therapy and is taught about prevention and continuing treatment of VTE. The nurse determines that discharge teaching for the patient has been effective when the patient makes which statement?

A. I should expect that coumadin will cause my stools to be somewhat black

B. i should avoid all dark green and leafy vegetables while I am taking coumadin.

C. massaging my legs several times a day will help increase my venous circulation

D. swimming is a good activity to include in my exercise program to increase my circulation.

D

Swimming is a good activity to include in my exercise program to increase my circulation.

swimming is particularly beneficial because of the gentle, even pressure of the water.

The nurse teaches the patient with any venous disorder that the best way to prevent venous stasis and increase venous return is to

A. walk

B. sit with the legs elevated

C. frequently rotate the ankles

D. continuously wear elastic compression stockings

A

during walking, the muscles of the legs continuously knead the veins, promoting movement of venous blood toward the heart. walking is the best measure to prevent venous stasis.

What is the most important measure in the treatment of venous stasis ulcers?

A. elevation of the limb

B. elastic compression stockings

C. application of moist dressings

D. application of topical antibiotics

B

elastic compression stockings provide extrinsic compression to minimize venous stasis, venous hypertension and edema