Deck 53: Management of Clients with Vascular Disorders

Question 1

.Before a client's amputation, the nurse would counsel that the client may experience "phantom sensation" after surgery, which is

A) the sensation that the leg is still there.
B) experiencing painful feelings in the amputated leg.
C) neuropathy that may delay prosthesis fitting.
D) part of establishing a new center of gravity.

Answer 1

the sensation that the leg is still there.

Question 2

For a client with deep vein thrombosis (DVT), the nurse would include in the plan of nursing care the intervention of

A) applying cool compresses to the area.
B) maintaining the legs in the dependent position.
C) raising the foot of the bed 6 inches.
D) restricting fluids.

Answer 2

raising the foot of the bed 6 inches.

Question 3

A client is scheduled to have a femoral-popliteal bypass with a synthetic graft. The nurse's preoperative teaching would include information about preoperative

A) antibiotics.
B) anticoagulants.
C) platelets.
D) skin preparation.

Answer 3

antibiotics.

Question 4

A client is wearing sequential compression devices (SCDs) on the bilateral lower legs. Nursing care for these devices includes

A) not allowing the client to ambulate.
B) pre-wrapping the legs with Ace bandages.
C) removing them twice a day to inspect skin.
D) turning them off every 2 hours for 10 minutes.

Question 5

The nurse explains to a client started on daily doses of Plavix after femoral bypass surgery that the purpose of this regimen is to

A) decrease platelet aggregation.
B) decrease postoperative pain.
C) increase vasodilation in the legs.
D) prevent postoperative fever.

Question 6

An appropriate nursing diagnosis to guide self-care teaching for a client who has lymphedema is

A) Impaired Adjustment.
B) Risk for Disuse Syndrome.
C) Risk for Fluid Volume Excess.
D) Risk for Infection.

Question 7

The nurse would inform a client diagnosed with a 2-cm aneurysm that such aneurysms usually require

A) a resection.
B) grafting.
C) medications to raise BP.
D) semi-annual ultrasound.

Question 8

When teaching foot care to a client with chronic arterial occlusive disease, the nurse would tell the client to avoid

A) using cornstarch on the feet.
B) using toenail clippers.
C) wearing canvas shoes.
D) wearing cotton socks.

Question 9

When a client complains of heaviness, aching, and itching of both legs for the past year, the nurse recognizes these complaints as being most suggestive of

A) Buerger's disease.
B) deep vein thrombosis.
C) Raynaud's phenomenon.
D) varicose veins.

Question 10

A female client with Raynaud's disease asks the nurse why she is taking the same calcium channel blocker that her brother-in-law takes for a heart condition. The nurse's response would include information that the calcium channel blocker will relieve some clinical manifestations of Raynaud's disease by

A) decreasing vasospasm.
B) increasing cardiac output to increase circulation.
C) increasing vasodilation.
D) reducing the pain in the extremities.

Question 11

To prevent skin breakdown of a client's stump, the nurse teaches the client to

A) adjust the prosthesis if it causes discomfort.
B) apply alcohol to the stump to toughen the skin.
C) wash the stump daily with mild soap, and then rinse and dry it.
D) wear cotton stump socks.

Question 12

In the exercise teaching plan for a client with chronic arterial occlusive disease, the nurse would caution the client to

A) avoid exercising the feet in the dependent position.
B) elevate feet periodically for 30 minutes.
C) not walk if an open ulcer forms.
D) walk a little farther each day even if pain occurs.

Question 13

The nurse is caring for a client who is taking warfarin sodium (Coumadin) for a history of DVT. Before administering the medication, the nurse should assess the client's

A) Homan's sign.
B) PT, INR.
C) PTT.
D) vital signs.

Question 14

The nurse teaches the client with intermittent claudication that the pain results from

A) lactic and pyruvic acid buildup.
B) muscle cramps.
C) rapid vasodilation in the legs.
D) venous stasis.

Question 15

The nurse would explain to a client that anticoagulant therapy is used in the treatment of thromboembolic disease because anticoagulants can

A) decrease blood viscosity.
B) dissolve the thrombi.
C) inhibit the synthesis of clotting factors.
D) prevent absorption of vitamin K.

Question 16

A client is scheduled for computed tomography (CT) of the abdomen because of a suspected abdominal aortic aneurysm. The nurse would assess this client for

A) abdominal pain radiating down one or both legs.
B) abdominal rebound tenderness.
C) painful abdominal distention.
D) pulsating abdominal mass.

Question 17

A client is scheduled for a guillotine amputation and is crying, stating that he/she cannot live with "such an ugly leg." The information from the nurse that would best help the client cope with the upcoming surgery is to tell the client that

A) in another operation, the stump edge will be covered with a skin flap.
B) it is either have the amputation or die from the infection.
C) later cosmetic surgery is an option if the amputation cures the infection.
D) while wearing a prosthesis, no one will be able to see the "ugly leg."

Question 18

For the first 24 hours after a client's leg amputation, the nurse would place the stump

A) Below the level of the heart.
B) elevated on a pillow.
C) flat on the bed.
D) in external rotation.

Question 19

For a client admitted with a history of chronic arterial insufficiency, the nurse would anticipate that physical assessment will reveal

A) rubor with elevation of feet.
B) pallor when feet are dependent.
C) diminished pedal pulses.
D) warm, edematous skin.

Question 20

Immediately after a client's revascularization surgery, the nurse would position the client with the

A) feet elevated on pillows.
B) legs flexed with the knee gatch up.
C) legs separated with pillows.
D) operative leg totally flat.

Question 21

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.

Question 22

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.

Question 23

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.

Question 24

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.

Question 25

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.

Question 26

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.

Question 27

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.

Question 28

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.

Question 29

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.

Question 30

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.

Question 31

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.

Question 32

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.

Question 33

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.

Question 34

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.

Question 35

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.

Question 36

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.

Question 37

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.

Question 38

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.