Question 1

A 75-year-old patient is diagnosed with chronic venous insufficiency. What should the nurse instruct this patient?

Accepted Answer

The nurse should instruct the patient to avoid the use of knee-high hose or girdles, as these can restrict venous flow and exacerbate chronic venous insufficiency. Keeping the legs in a dependent position, limiting ambulation, and dangling legs over the side of the bed are not recommended interventions for chronic venous insufficiency. Instead, the patient should be encouraged to elevate the legs above the level of the heart when sitting or lying down and engage in regular exercise to improve venous tone.

Question 2

An older patient is prescribed elastic graduated compression stockings. What should the nurse instruct the patient about these stockings?

Accepted Answer

The nurse should instruct the patient to remove the stockings once per day and while sleeping to allow the skin to breathe and to check for any signs of skin irritation or breakdown.

Question 3

A patient is seen for increasing edema in his left lower extremity and pain in the limb with ambulation. What should the nurse suspect is occurring in this patient?

Accepted Answer

Increasing edema and pain with ambulation are classic symptoms of deep vein thrombosis (DVT), which is a blood clot in the deep veins of the legs. Arterial occlusion may present with similar symptoms, but the edema is often minimal or absent due to lack of blood flow. Superficial vein thrombosis and varicose veins may cause pain and swelling, but usually do not cause significant edema or pain with ambulation.

Question 4

A patient with diabetes is beginning treatment for hypertension. What should the nurse explain as being the blood pressure treatment goal for this patient?

Accepted Answer

The blood pressure treatment goal for a patient with diabetes is <130/80 mmHg. This goal is lower than that for the general population because individuals with diabetes are at a higher risk for cardiovascular disease.

Question 5

The nurse calls a patient at home with the laboratory results from his visit of earlier in the day. Based on a review of these results, what does the nurse expect the healthcare provider to advise? $$\begin{array}{l}

\begin{array} { | l | l| } 
\hline \text { Laboratory }\
\text { Results } & \
\hline \text { PT (prothrombin) } & \begin{array} { l } 
\text { Within } \
\text { therapeutic } \
\text { range }
\end{array} \
\hline \text { INR } & 2.4 \
\hline
\end{array}
\end{array}$$

Accepted Answer

The INR value of 2.4 indicates that the patient's blood is within the therapeutic range, but on the higher end. Therefore, the healthcare provider is likely to advise maintaining the same daily dose of warfarin (Coumadin). Option A is not correct because heparin is not mentioned in the laboratory results. Option C is not correct because increasing the dose of warfarin (Coumadin) can put the patient at risk of bleeding. Option D is not correct because stopping warfarin (Coumadin) abruptly can increase the risk of blood clots.

Question 6

The nurse is instructing a patient with hypertension about lifestyle modifications. What would be appropriate to include in the teaching for this patient?

Accepted Answer

A - Reviewing the Dietary Approaches to Stop Hypertension (DASH) diet is appropriate as it is a dietary plan recommended for individuals with hypertension. 
B - Starting a walking program and increasing it to 30 minutes for 5 or 6 days per week is beneficial for overall cardiovascular health and can help to lower blood pressure. 
C - While exercise is important, weight lifting is not typically recommended as the main form of exercise for patients with hypertension. 
D - Eliminating dairy products from the diet is not necessary unless the patient has an allergy or intolerance to dairy products. 
E - Restricting fluid intake is not appropriate unless the patient has another medical condition that requires fluid restriction.

Question 7

During the abdominal assessment of an elderly patient, the nurse palpates a mass in the midabdomen. What should the nurse do next?

Accepted Answer

The answer of During the abdominal assessment of an elderly...

Question 8

A patient is diagnosed with thromboangiitis obliterans. What would be appropriate teaching for this patient?

Accepted Answer

Thromboangiitis obliterans is strongly associated with smoking, and smoking cessation can help manage the disorder. Medications and surgical procedures can help alleviate symptoms but are not a cure. Therefore, cessation of smoking is the most appropriate teaching for a patient with this diagnosis. Option A implies a cure, which is not the case. Option B suggests surgery to cure, but this is not possible for thromboangiitis obliterans. Option D is not accurate, as management and alleviating symptoms are possible, even if a complete cure is not available.

Question 9

A patient is being discharged on long-term oral anticoagulant therapy for arterial thrombus formation in the lower extremity. What should be included in this patient's discharge instructions?

Accepted Answer

The patient should be instructed to contact the physician's office for follow-up laboratory studies in order to monitor the effectiveness and safety of the anticoagulant therapy. Bleeding from the nose is not expected and should be reported to the physician. Pain in the limb can be a sign of complications and should also be reported to the physician. Taking two doses if a dose is missed is not recommended and could increase the risk of bleeding.

Question 10

A patient's blood pressure continues to be elevated despite being prescribed an ACE inhibitor for several weeks. What should the nurse do at this time?

Accepted Answer

The nurse should first verify if the patient is taking the medication as prescribed, as non-compliance is a common reason for treatment failure.

Question 11

A patient with a deep vein thrombosis (DVT) is going to be weaned from intravenous heparin. When should the nurse anticipate that oral warfarin sodium would be prescribed?

Accepted Answer

Oral warfarin sodium is usually started four to five days before discontinuing intravenous heparin to allow time for the warfarin to reach a therapeutic level and prevent a lapse in anticoagulation therapy.

Question 12

A patient is demonstrating signs of thrombophlebitis. With this disorder, the nurse realizes that three mechanisms occur, which include:

Accepted Answer

Thrombophlebitis is caused by the inflammation of a vein due to blood clots (thrombus) that form within the vein. The three mechanisms involved in thrombophlebitis are blood hypercoagulation, stasis of blood flow, and vessel damage. Pooling of blood in the vessel and elevated systemic blood pressure are not directly related to thrombophlebitis.

Question 13

The nurse suspects a patient recovering from an abdominal aortic aneurysm repair is experiencing graft leaking. What findings did the nurse use to make this clinical decision?

Accepted Answer

Complaint of groin pain and back discomfort are both indicative of graft leaking after an abdominal aortic aneurysm repair. Urine output, abdominal dressing, and respiratory rate do not necessarily provide information about graft leaking.

Question 14

A patient is demonstrating signs of ineffective peripheral tissue perfusion. What intervention would be appropriate for this patient?

Accepted Answer

Smoking is a major risk factor for ineffective peripheral tissue perfusion, so discussing smoking cessation techniques would be an appropriate intervention for the patient. Encouraging the patient to reduce exercise would not necessarily address the underlying cause of the problem, and keeping extremities cool or assisting with pillow placement would not necessarily improve tissue perfusion.

Question 15

The nurse suspects that a patient is experiencing the effects of peripheral atherosclerosis. What did the nurse most likely assess in this patient?

Accepted Answer

Peripheral atherosclerosis is a condition in which the arteries in the legs become narrowed or blocked due to plaque buildup. This can cause symptoms such as leg pain, cramping, or numbness, especially during physical activity or at rest. Rubor with extremity elevation (redness when the extremity is raised above the heart) is a sign of dependent rubor, which can be a sign of arterial insufficiency, but it is not specific to peripheral atherosclerosis. Normal hair distribution and peripheral pulses would also not be affected by peripheral atherosclerosis.

Question 16

A patient who is being treated for a deep vein thrombosis (DVT) complains of chest pain and shortness of breath. What should the nurse do first?

Accepted Answer

Chest pain and shortness of breath are signs of a potential pulmonary embolism, which can be a life-threatening complication of a DVT. Therefore, the priority action is to elevate the head of the bed to improve oxygenation and begin oxygen therapy. This is to ensure that the patient receives adequate oxygenation and to prevent further complications. The other options may be assessed later but are not the priority at this time.

Question 17

The nurse measures a patient's blood pressure as 144/88 mmHg. What intervention would be most appropriate for this patient?

Accepted Answer

Remeasuring the blood pressure can confirm the initial reading and rule out any errors or temporary factors affecting the measurement.

Question 18

A co-worker asks the nurse is to review the following discharge instructions with an assigned patient. Based on the content to be reviewed, the nurse should realize that the patient has what health problem? $$\begin{array} { | c | l |} 
\hline \begin{array} { l } 
\text { Discharge } \
\text { Instructions }
\end{array} & \text { Name: } \
\hline 1 . & \begin{array} { l } 
\text { Follow-up appointment with smoking cessation program on (date } \
\text { included). }
\end{array} \
\hline 2 . & \begin{array} { l } 
\text { Avoid exposure to cold temperatures or handling cold objects. Wear } \
\text { gloves. Dress warmly. }
\end{array} \
\hline 3 . & \text { Prevent injury to the extremities. } \
\hline 4 . & \begin{array} { l } 
\text { Take calcium channel blocker medication nifedipine (Procardia) as } \
\text { prescribed. }
\end{array} \
\hline 5 . & \begin{array} { l } 
\text { Follow-up appointment with stress management program on (date } \
\text { included). }
\end{array} \
\hline 6 . & \text { Call physician's office for one-month follow-up appointment. }\
\hline
\end{array}$$

Accepted Answer

The instructions to avoid exposure to cold temperatures and to wear gloves and dress warmly, as well as the instruction to prevent injury to the extremities, indicate that the patient likely has Raynaud disease, a condition in which the blood vessels in the fingers and toes constrict in response to cold or stress, causing pain, numbness, and tingling. The follow-up appointment with a stress management program also supports this diagnosis. The other conditions listed do not typically involve the symptoms or management described in the discharge instructions.

Question 19

A patient is having segmental pressure measurements conducted to help diagnose peripheral vascular disease. What finding would indicate the presence of this disorder?

Accepted Answer

In a patient with peripheral vascular disease, there may be obstruction or narrowing of the blood vessels in the legs leading to decreased blood flow and pressure in the affected area. Therefore, a finding of calf pressure lower than the arm would indicate the presence of this disorder.

Question 20

The nurse is planning care for a patient who was diagnosed with deep vein thrombosis (DVT). What should be included in this plan of care?

Accepted Answer

Elastic antiembolism stockings are used in the management of deep vein thrombosis (DVT) to help prevent the formation of further clots by promoting venous return and reducing venous stasis.

Quiz 32: Nursing Care of Patients With Vascular and Lymphatic Disorders