Chapter 36 - Care of Patients with Vascular Problems
Which client who has just arrived in the emergency department does the nurse classify as emergent and needing immediate medical evaluation?
- A 60-year-old with venous insufficiency who has new-onset right calf pain and tenderness
- A 64-year-old with chronic venous ulcers who has a temperature of 100.1°F (37.8°C)
- A 69-year-old with a 40-pack-year cigarette history who is reporting foot numbness
- A 70-year-old with a history of diabetes who has “tearing” back pain and is diaphoretic
D. A 70-year-old with a history of diabetes who has “tearing” back pain and is diaphoretic
The nurse is caring for a client who is being treated for hypertensive emergency. Which medication prescribed for the client would the nurse question?
- Enalapril (Vasotec)
- Sodium nitroprusside (Nipride)
- Dopamine (Intropin)
- Labetalol (Normodyne)
C. Dopamine (Intropin)
Which vascular assessment by the student nurse requires intervention by the supervising nurse?
- Measuring capillary refill in the fingertips
- Assessing pedal pulses by Doppler
- Measuring blood pressure in both arms
- Simultaneously palpating the bilateral carotids
D. Simultaneously palpating the bilateral carotids
A client with peripheral arterial disease (PAD) has undergone percutaneous transluminal angioplasty (PTA) of the lower extremity. What is essential for the nurse to assess after the procedure?
- Ankle-brachial index
- Dye allergy
- Pedal pulses
- Gag reflex
C. Pedal pulses
A client is receiving unfractionated heparin (UFH) by infusion. Of which finding does the nurse notify the primary health care provider (PCP)?
- Partial thromboplastin time (PTT) 60 seconds
- Platelets 32,000/mm3 (32 × 109/L)
- White blood cells 11,000/mm3 (11 × 109/L)
- Hemoglobin 12.2 g/dL (122 mmol/L)
B. Platelets 32,000/mm3 (32 × 109/L)
When caring for a client with an abdominal aortic aneurysm (AAA), the nurse suspects dissection of the aneurysm when the client makes which statement?
- “I feel my heart beating in my abdominal area.”
- “I just started to feel a tearing pain in my belly.”
- “I have a headache. May I have some acetaminophen?”
- “I have had hoarseness for a few weeks.”
B. “I just started to feel a tearing pain in my belly.”
The nurse caring for a client who has had abdominal aortic aneurysm (AAA) repair would be most alarmed by which finding?
- Urine output of 20 mL over 2 hours
- Blood pressure of 106/58 mm Hg
- Absent bowel sounds
- +3 pedal pulses
A. Urine output of 20 mL over 2 hours
Which symptom reported by a client who has had a total hip replacement requires emergency action?
- Localized swelling of one of the lower extremities
- Positive Homans’ sign
- Shortness of breath and chest pain
- Tenderness and redness at the IV site
C. Shortness of breath and chest pain
The nurse is teaching a client the precautions to take while on warfarin (Coumadin) therapy. Which statement made by the client demonstrates that teaching has been effective?
- “I can use an electric razor or a regular razor.”
- “Eating foods like green beans won’t interfere with my Coumadin therapy.”
- “If I notice I am bleeding a lot, I should stop taking Coumadin right away.”
- “When taking Coumadin, I may notice some blood in my urine.”
B. “Eating foods like green beans won’t interfere with my Coumadin therapy.”
The nurse is caring for a client with dark-colored toe ulcers and blood pressure (BP) of 190/100 mm Hg. Which nursing action does the nurse delegate to the LPN/LVN?
- Assess leg ulcers for evidence of infection.
- Administer a clonidine patch for hypertension.
- Obtain a request from the health care provider for a dietary consult.
- Develop a plan for discharge, and assess home care needs.
B. Administer a clonidine patch for hypertension.
The nurse in the cardiology clinic is reviewing teaching about hypertension, provided at the client’s last appointment. Which actions by the client indicate that teaching has been effective? Select all that apply.
- Has maintained a low-sodium, no-added-salt diet
- Has lost 3 pounds (1.4 kg) since last seen in the clinic
- Cooks food in palm oil to save money
- Exercises once weekly
- Has cut down on caffeine
A. Has maintained a low-sodium, no-added-salt diet
B. Has lost 3 pounds (1.4 kg) since last seen in the clinic
E. Has cut down on caffeine
A client has undergone an embolectomy for acute arterial occlusion after creation of a lower arm arteriovenous fistula for dialysis. Which finding does the nurse report to the primary health care provider (PCP) immediately?
- Swelling and tenseness in the affected area
- Incisional pain and tenderness at the surgical site
- Pink, mobile fingers
- An order for heparin infusion
A. Swelling and tenseness in the affected area
Which sign/symptom is essential for the nurse to report to the primary health care provider (PCP) when caring for a client with Raynaud’s phenomenon?
- Nifedipine (Procardia) administration caused the blood pressure to change from 134/76 to 110/68 mm Hg.
- The client’s extremity became white, then red temporarily.
- The affected extremity becomes purple and cold.
- The client states that the digits are painful when they are white.
C. The affected extremity becomes purple and cold.
For a client with an 8-cm abdominal aortic aneurysm, which problem must be addressed immediately to prevent rupture?
- Heart rate 52 beats/min
- Blood pressure (BP) 192/102 mm Hg
- Report of constipation
B. Blood pressure (BP) 192/102 mm Hg
The nurse is teaching a young female client how to prevent venous thromboembolism specific to her hospital stay after intensive orthopedic surgery. Which statement made by the client indicates the need for further teaching?
- “I must stop taking my birth control pills.”
- “I should drink lots of water so I don’t get dehydrated.”
- “I should exercise my legs when I have been sitting or standing for a long time.”
- “If I wear pantyhose, I won’t have to wear the stockings the hospital gives me.”
D. “If I wear pantyhose, I won’t have to wear the stockings the hospital gives me.”
A client with hypertension is started on verapamil (Calan). What teaching does the nurse provide for this client?
- “Consume foods high in potassium.”
- “Monitor for irregular pulse.”
- “Monitor for muscle cramping.”
- “Avoid grapefruit juice.”
D. “Avoid grapefruit juice.”
The client undergoing femoral popliteal bypass states that he is fearful he will lose the limb in the near future. Which response by the nurse is most therapeutic?
- “Are you afraid you will not be able to work?”
- “If you control your diabetes, you can avoid amputation.”
- “Your concerns are valid; we can review some steps to limit disease progression.”
- “What about the situation concerns you most?”
C. “Your concerns are valid; we can review some steps to limit disease progression.”
Which finding in the history of a client with an abdominal aortic aneurysm (AAA) is a risk factor for aneurysm formation?
- Peptic ulcer disease
- Deep vein thrombosis (DVT)
- Marfan syndrome
D. Marfan syndrome
The nurse is assigned to all of these clients. Which client would be assessed first?
- The client who had percutaneous transluminal angioplasty (PTA) of the right femoral artery 30 minutes ago
- The client admitted with hypertensive crisis who has a nitroprusside (Nipride) drip and blood pressure of 149/80 mm Hg
- The client with peripheral vascular disease who has a left leg ulcer draining purulent yellow fluid
- The client who had a right femoral-popliteal bypass 3 days ago and has ongoing edema of the foot
A. The client who had percutaneous transluminal angioplasty (PTA) of the right femoral artery 30 minutes ago
The nurse teaches a client who has had a myocardial infarction (MI) which information regarding diet?
- Less than 30% of the daily caloric intake should be derived from proteins.
- Use canola oil rather than palm oil.
- Consume 10 mg of fiber daily.
- Work toward lowering your high-density lipoprotein (HDL) cholesterol levels.
B. Use canola oil rather than palm oil.
A client has just undergone arterial revascularization. Which statement by the client indicates a need for further teaching related to postoperative care?
- “My leg might turn very white after the surgery.”
- “I must be concerned if my foot turns blue.”
- “I must report a fever or any drainage.”
- “Warmness, redness, and swelling are expected.”
A. “My leg might turn very white after the surgery.”
Which teaching point does the nurse include for a client with peripheral arterial disease (PAD)?
- “Elevate your legs above heart level to prevent swelling.”
- “Inspect your legs daily for brownish discoloration around the ankles.”
- “Walk to the point of leg pain, then rest, resuming when pain stops.”
- “Apply a heating pad to the legs if they feel cold.”
C. “Walk to the point of leg pain, then rest, resuming when pain stops.”
When administering furosemide (Lasix) to a client who does not like bananas or orange juice, the nurse recommends that the client try which intervention to maintain potassium levels?
- Increase red meat in the diet.
- Consume melons and baked potatoes.
- Add several portions of dairy products each day.
- Try replacing your usual breakfast with oatmeal or Cream of Wheat.
B. Consume melons and baked potatoes.
A client’s medical record shows these data: Physical Assessment Findings Diagnostic Findings Provider Prescriptions Crackles at bases PTT 55 seconds Lovenox 40 mg twice daily Right leg swelling POSITIVE, D-dime rElevate right leg Right calf pain hCG negative Doppler study right leg. Which finding confirms the presence of a thromboembolism?
- Human chorionic gonadotropin (hCG) negative
- Crackles at bases
- Positive D-dimer (>0.5mg/L)
- Right leg swelling
C. Positive D-dimer (>0.5mg/L)
The nurse suspects that a client has developed an acute arterial occlusion of the right lower extremity based on which signs/symptoms? Select all that apply.
- Bounding right pedal pulses
- Cold right foot
- Numbness and tingling of right foot
- Mottling of right foot and lower leg
D. Cold right foot
E. Numbness and tingling of right foot
F. Mottling of right foot and lower leg
Which are risk factors that are known to contribute to atherosclerosis-related diseases? Select all that apply.
- Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL (4.14 mmol/L)
- Aspirin (acetylsalicylic acid [ASA]) consumption
- Type 2 diabetes
- Vegetarian diet
A. Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL (4.14 mmol/L)
D. Type 2 diabetes
The professional nurse and the nursing student are caring for a group of clients with hypertension. Which problem identified by the nursing student correctly identifies the client at risk for secondary hypertension?
- Psychiatric disturbance
- High sodium intake
- Physical inactivity
- Kidney disease
D. Kidney disease
While caring for a client who has received recombinant tissue plasminogen activator (t-PA) for a large deep vein thrombus, the nurse becomes most concerned when the client develops which condition?
- Small amount of blood at the IV insertion site
- Heavy menstrual bleeding
- +1 pitting edema of the affected extremity
- Client stating that the year is 1967
D. Client stating that the year is 1967
The nurse is caring for a client with peripheral arterial disease (PAD). For which symptoms does the nurse assess?
- Reproducible leg pain with exercise
- Unilateral swelling of affected leg
- Decreased pain when legs are elevated
- Pulse oximetry reading of 90%
A. Reproducible leg pain with exercise
All of these client assignments have been made by the charge nurse. Which assignment is questionable?
- The RN with 3 years of experience caring for a client with a pulmonary embolism (PE) who is receiving heparin therapy
- The LPN/LVN with 5 years of experience caring for a client with leg ulcers who is awaiting nursing home placement
- The RN with 8 years of experience caring for a client with peripheral arterial disease (PAD) and a total cholesterol of 390 mg/dL (10.1 mmol/L)
- The LPN/LVN with 20 years of experience caring for a client with a headache whose blood pressure (BP) is 210/150 mm Hg
D. The LPN/LVN with 20 years of experience caring for a client with a headache whose blood pressure (BP) is 210/150 mm Hg