Question 1

A client is scheduled for a below-the-knee amputation for treatment of chronic infected arterial ulcers and leg pain. The client seems calm, and even happy. The nurse should respond to this client based on understanding that the client
A) cannot cope effectively with a life-altering procedure.
B) is experiencing dysfunctional grieving for the leg.
C) may prefer an amputation to living with chronic pain.
D) might have cognitive defects preventing full understanding.

Accepted Answer

Assessment of the client's attitude towards amputation is a vital preoperative assessment. While all options are certainly possible, some clients who suffer from chronic ischemia might prefer an amputation to living with pain and disability. This is an important quality of life value and should be assessed in order to plan holistic postoperative care.

Question 2

A client is scheduled for discharge to home after repair of an abdominal aortic aneurysm. As an acceptable activity during the first 6 to 12 weeks after surgery, the nurse would suggest
A) mowing the lawn.
B) vacuuming the floor.
C) walking.
D) washing windows.

Accepted Answer

Activities that involve lifting heavy objects, usually more than 15 to 20 pounds, are not permitted for 6 to 12 weeks postoperatively. Activities that involve pushing, pulling, or straining may also be restricted. Driving may be restricted because of postoperative weakness and decreased response time. Walking is acceptable. Clients can resume sexual activity within 4-6 weeks; however, the risk of impotence should be discussed preoperatively with male clients.

Question 3

A client who is receiving IV heparin has a PTT reported by the lab as 101. Appropriate actions by the nurse include (Select all that apply)
A) continuing to monitor the heparin infusion.
B) instituting safety precautions.
C) notifying the physician.
D) ordering another PTT in the morning.
E) turning off the heparin IV.

Accepted Answer

Bleeding can occur in the client receiving anticoagulant therapy. Heparin infusions are monitored with the PTT. Therapeutic levels are generally greater than 60, but at 1.5-2.5 times the baseline (normal is around 25-35). A PTT of 101 is a critical result and the nurse should (1) stop the heparin infusion, (2) notify the physician, and (3) place the client on bleeding precautions. A small injury to the client can cause bleeding. The client can also have spontaneous bleeding. The nurse should observe the client for bleeding, as evidenced by frank hemorrhage, changes in mental status, pink-tinged or frank blood in the urine, dark or tarry stools, and bleeding after brushing the teeth.

Question 4

A client who is overweight and smokes is newly diagnosed with thromboangiitis obliterans. The nurse's teaching plan would focus on the highest priority of
A) controlling high blood pressure.
B) exercising regularly.
C) following a low-fat diet.
D) smoking cessation.

Accepted Answer

The need for smoking cessation must be clearly and unequivocally conveyed to the client and family.

Question 5

A client is recovering from a leg amputation and is doing well. However, the nurse still cautions the client to
A) avoid any trips with the new prosthesis in the next year or so.
B) call for help when getting out of bed.
C) limit pain medication to prevent dizziness at therapy.
D) not be too excited about progress until fitted with the prosthesis.

Accepted Answer

A client with an amputation has to learn to adapt to a new center of gravity, making transfers and ambulation potentially difficult. Until the client has completely adapted, he/she will need assistance with ambulation and transfers, even if just going from bed to chair, to prevent injury. Clients may even need assistance turning in bed until they adapt.

Question 6

Important health promotion measures a nurse could teach a client in order to avoid another episode of DVT include (Select all that apply)
A) avoiding prolonged sitting.
B) elevating the legs when sitting.
C) maintaining an ideal body weight.
D) remaining hydrated.

Accepted Answer

Virchow's triad describes the pathophysiologic conditions that have to exist in order to have a DVT. The components are venous stasis (caused by immobilization, prolonged travel, pregnancy, lack of use of the calf muscle pump, and heart disease, among others), hypercoagulability (caused by dehydration, blood dyscrasias, and oral contraceptives, among other things), and vascular injury (caused by fractures, trauma, dislocations, and chemical irritation, among other things). Two of the three factors must be present to form a DVT.

Question 7

When a client scheduled for insertion of a vena cava filter begins to sweat and becomes diaphoretic, the nurse would recognize these clinical manifestations as
A) cerebrovascular accident.
B) myocardial infarction.
C) onset of pneumonitis.
D) pulmonary embolism.

Accepted Answer

These are cardinal manifestations of a pulmonary embolism, which requires immediate intervention.

Question 8

When a client who has been taking warfarin (Coumadin) for 2 years tells the nurse of plans for oral surgery, the nurse would caution the client to
A) avoid taking aspirin for postoperative pain.
B) contact the physician to arrange vitamin K injections before surgery.
C) obtain an International Normalized Ratio (INR) 1 day before surgery.
D) stop taking Coumadin for 3 or 4 days before surgery.

Accepted Answer

Warfarin has a long half-life of 3 to 4 days. Before surgery the client should cease taking Coumadin for that period.

Question 9

The nurse would inform a client with a venous ulcer that the client's ulcer will be treated with the traditional protocol of
A) daily warm soaks and application of wet-to-moist saline dressings.
B) enzymatic debridement and the area left open to air.
C) local antibiotic ointment applied twice a day.
D) pressure dressing left in place for 5 to 7 days.

Accepted Answer

No topical treatment for venous ulcer is adequate without a compression dressing capable of sustaining pressure for at least 1 week.

Question 10

For a hospitalized client who experienced a sudden arterial occlusion yesterday, the nurse would review the chart for a history of
A) atrial fibrillation.
B) hypertension.
C) iron deficiency anemia.
D) oral contraceptive use.

Accepted Answer

Emboli, the most common cause of sudden ischemia, usually are of cardiac origin during periods of atrial fibrillation.

Question 11

When a client with arterial insufficiency complains of being awakened at night by pain in the legs, the nurse would recommend that the client sleep
A) after exercising for 10 to 15 minutes.
B) in a recliner with feet dependent.
C) propped up by several pillows.
D) with legs covered by an extra blanket.

Accepted Answer

Placing the legs in a dependent position provides increased gravitational blood supply.

Question 12

The nurse reading the admission note for a client who has an arterial leg ulcer would anticipate that the ulcer will be characterized
A) as being surrounded by atrophic tissue.
B) as producing minimal pain.
C) by a deep-red base.
D) by irregular borders.

Accepted Answer

Arterial leg ulcers are very painful, which distinguishes them from venous stasis ulcers. Arterial ulcers also have a sharp edge and a pale base and often are surrounded by atrophic tissue.

Question 13

The nurse working in the emergency department (ED) receives a telephone call from an individual who states a co-worker's finger was amputated and asks what should be done. The nurse would tell the caller to immediately
A) pack the finger immediately in a plastic bag filled with ice.
B) place the finger in a bowl full of cool water or normal saline, if available.
C) wash and rinse the finger and wrap it in a clean, warm towel.
D) wrap the finger in a clean cloth and place it in a plastic bag, then on ice.

Accepted Answer

The limb should be wrapped in a cloth and placed in a plastic bag and then on ice. The limb or digit should not come in contact with ice or water to prevent direct tissue damage.

Question 14

A nurse suspects a client has an acute arterial occlusion. Early assessment findings that would confirm her suspicion include (Select all that apply)
A) pain.
B) pallor.
C) paralysis.
D) paresthesias
E) pulselessness.

Accepted Answer

Early signs are pain, pallor, and pulselessness. Paresthesias indicate advanced damage. Paralysis indicates irreversible damage.

Question 15

The nurse caring for a client with a traumatic arm amputation knows that care will be significantly different from other clients with amputations because
A) clients with traumatic amputations are usually young and get well fast.
B) the postoperative complication rate is lower than with venous insufficiency.
C) the surgery to repair the limb is not as involved as with arterial insufficiency.
D) there was no time beforehand to grieve the loss of the limb.

Accepted Answer

In a planned amputation, the client has some time before the operation to grieve the upcoming loss of limb and to begin to incorporate this into a new self-identity. With traumatic amputations, the client has no warning and no time to grieve or to adjust beforehand.

Question 16

A client scheduled for a repair of an abdominal aortic aneurysm reports increased abdominal pain accompanied by new onset of intense back and flank pain. The priority action by the nurse would be to
A) administer a prescribed analgesic.
B) notify the physician immediately.
C) reassess the client in another 5 minutes.
D) take another set of vital signs.

Accepted Answer

Ruptured abdominal aortic aneurysm presents with a triad of manifestations, including abdominal pain combined with intense back and flank pain and possible scrotal pain, a pulsating abdominal mass or a rigid abdomen from the hemorrhage, and shock. Surgery is the only intervention for clients with a ruptured abdominal aortic aneurysm.

Question 17

In teaching the preoperative ambulatory surgery client scheduled for vein ligation and stripping, the nurse would include that immediately after surgery, the client will
A) experience pain and swelling in the leg.
B) have legs wrapped with Ace bandages from heel to groin.
C) have the head of the bed put on blocks to elevate it 6 to 9 inches.
D) need to sit in a comfortable chair with legs dependent.

Accepted Answer

Elastic compression bandages are applied from foot to groin. The legs should not be dependent. There will be some pain, which can be managed.

Question 18

A client's blood pressure is (150/76) mm Hg in the brachial artery and (162/80) mm Hg in the tibialis artery. After computing the A/B index, the nurse would record that the client's index indicates
A) a normal ratio.
B) mild ischemia.
C) moderate ischemia.
D) severe ischemia.

Accepted Answer

The ankle systolic pressure (A) is divided by the brachial pressure (B): (80/76)=1.04. The normal A/B value is more than 1; the value is 0.5 in severe disease.

Quiz 53: Management of Clients with Vascular Disorders

A client is scheduled for a below-the-knee amputation for treatment of chronic infected arterial ulcers and leg pain. The client seems calm, and even happy. The nurse should respond to this client based on understanding that the client

A client is scheduled for discharge to home after repair of an abdominal aortic aneurysm. As an acceptable activity during the first 6 to 12 weeks after surgery, the nurse would suggest

A client who is receiving IV heparin has a PTT reported by the lab as 101. Appropriate actions by the nurse include (Select all that apply)

A client who is overweight and smokes is newly diagnosed with thromboangiitis obliterans. The nurse's teaching plan would focus on the highest priority of

A client is recovering from a leg amputation and is doing well. However, the nurse still cautions the client to

Important health promotion measures a nurse could teach a client in order to avoid another episode of DVT include (Select all that apply)

When a client scheduled for insertion of a vena cava filter begins to sweat and becomes diaphoretic, the nurse would recognize these clinical manifestations as

When a client who has been taking warfarin (Coumadin) for 2 years tells the nurse of plans for oral surgery, the nurse would caution the client to

The nurse would inform a client with a venous ulcer that the client's ulcer will be treated with the traditional protocol of

For a hospitalized client who experienced a sudden arterial occlusion yesterday, the nurse would review the chart for a history of

When a client with arterial insufficiency complains of being awakened at night by pain in the legs, the nurse would recommend that the client sleep

The nurse reading the admission note for a client who has an arterial leg ulcer would anticipate that the ulcer will be characterized

The nurse working in the emergency department (ED) receives a telephone call from an individual who states a co-worker's finger was amputated and asks what should be done. The nurse would tell the caller to immediately

A nurse suspects a client has an acute arterial occlusion. Early assessment findings that would confirm her suspicion include (Select all that apply)

The nurse caring for a client with a traumatic arm amputation knows that care will be significantly different from other clients with amputations because

A client scheduled for a repair of an abdominal aortic aneurysm reports increased abdominal pain accompanied by new onset of intense back and flank pain. The priority action by the nurse would be to

In teaching the preoperative ambulatory surgery client scheduled for vein ligation and stripping, the nurse would include that immediately after surgery, the client will

A client's blood pressure is (150/76) mm Hg in the brachial artery and (162/80) mm Hg in the tibialis artery. After computing the A/B index, the nurse would record that the client's index indicates