1.
The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit. The client, who exercises regularly, reports having pain in the calf during exercise that dis- appears at rest. Which of the following fi ndings requires further evaluation?■ 1. Heart rate 57 bpm.
■ 2. SpO2 of 94% on room air.
■ 3. Blood pressure 134/82.
■ 4. Ankle brachial index of 0.65.
2.
A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft.The blood pressure has decreased from 124/80 to 94/62. What should the nurse assess fi rst?
■ 1. IV fl uid solution.
■ 2. Pedal pulses.
■ 3. Nasal cannula fl ow rate.
■ 4. Capillary refi ll.
3.
An overweight client taking warfarin (Coumadin) has a nursing diagnosis of Ineffective tissue perfusion related to decreased arterial blood fl ow. What should the nurse instruct the client to do? Select all that apply.■ 1. Apply lanolin or petroleum jelly to intact skin.
■ 2. Encourage a reduced-calorie, reduced-fat diet.
■ 3. Inspect the involved areas daily for new ulcerations.
■ 4. Instruct the client to limit activities of daily living (ADLs).
■ 5. Use an electric razor to shave.
4.
Peripheral blood fl ow is dependent on which of the following variables?■ 1. Blood viscosity and diameter of vessels.
■ 2. Diameter and resistance of vessels.
■ 3. Force of contraction of the heart and resis- tance of vessels.
■ 4. Pressure differences in the arterial and venous systems and resistance.
5.
Blood pressure in the systemic circulation is highest in the:■ 1. Arterioles.
■ 2. Capillaries.
■ 3. Aorta.
■ 4. Venules.
6.
A common abnormal laboratory result associ- ated with the development of peripheral vascular disease (PVD) is:■ 1. High serum calcium level.
■ 2. High serum lipid levels.
■ 3. Low serum potassium level.
■ 4. Low serum lipid levels.
7.
The nurse is planning care for a client with a history of peripheral vascular disease who has symptoms of claudication. Nursing care should be directed to avoiding which of the following situations?■ 1. Oxygen demand by the muscle exceeds the supply.
■ 2. Oxygen demand and supply of the working muscle are in balance.
■ 3. Oxygen supply exceeds the demand of the working muscle.
■ 4. Oxygen is absent.
■ The Client with Peripheral Vascular Disease
■ The Client with Peripheral Vascular Disease Having an Amputation
■ The Client with Buerger’s Disease
■ The Client with Vasospastic Disorder
■ The Client with Thrombophlebitis and Embolus Formation
■ The Client with an Aneurysm
■ The Client with Stasis Ulcers
■ The Client with Peripheral Arterial Occlusive Disease
■ Managing Care Quality and Safety
■ Answers, Rationales, and Test Taking Strategies
The Client with Vascular Disease
2
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8.
Which of the following explains the infl uence of aging on the development of peripheral vascular disease?■ 1. Decreased resistance.
■ 2. Increased resistance.
■ 3. Decreased viscosity.
■ 4. Increased viscosity.
9.
The client admitted with peripheral vascu- lar disease (PVD) asks the nurse why her legs hurt when she walks. The nurse bases a response on the knowledge that the main characteristic of PVD is:■ 1. Decreased blood fl ow.
■ 2. Increased blood fl ow.
■ 3. Slow blood fl ow.
■ 4. Thrombus formation.
10.
The nurse is planning care for a client who is diagnosed with peripheral vascular disease (PVD) and has a history of heart failure. The nurse should develop a plan of care that is based on the fact that the client may have a low tolerance for exercise related to:■ 1. Decreased blood fl ow.
■ 2. Increased blood fl ow.
■ 3. Decreased pain.
■ 4. Increased blood viscosity.
11.
When assessing the lower extremities of a client with peripheral vascular disease (PVD), the nurse notes bilateral ankle edema. The edema is related to:■ 1. Competent venous valves.
■ 2. Decreased blood volume.
■ 3. Increase in muscular activity.
■ 4. Increased venous pressure.
12.
The nurse is obtaining the pulse of a client who has had a femoral-popliteal bypass surgery 6 hours ago. Which assessment provides the most accurate information about the client’s post- operative status?● 1.
● 2.
● 3.
● 4.
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13.
The nurse is teaching a client about risk factors associated with atherosclerosis and how to reduce the risk. Which of the following is a risk fac- tor that the client is not able to modify?■ 1. Diabetes.
■ 2. Age.
■ 3. Exercise level.
■ 4. Dietary preferences.
14.
The nurse is assessing the lower extremities of the client with peripheral vascular disease (PVD). Dur- ing the assessment, the nurse should expect to fi nd which of the following clinical manifestations of PVD?■ 1. Hairy legs.
■ 2. Mottled skin.
■ 3. Pink, cool skin.
■ 4. Warm, moist skin.
15.
The client has midcalf pain when walking a block or more. The client states that the discomfort is relieved with rest. The pain is expected when arterial occlusion reaches which of the following percentages?■ 1. 20%.
■ 2. 40%.
■ 3. 50%.
■ 4. 100%.
16.
The nurse is unable to palpate the client’s left pedal pulses. Which of the following actions should the nurse take next?■ 1. Auscultate the pulses with a stethoscope.
■ 2. Call the physician.
■ 3. Use a Doppler ultrasound device.
■ 4. Inspect the lower left extremity.
17.
When using a Doppler instrument to assess peripheral pulses, the correct placement of the transducer is important because it is diffi cult to dif- ferentiate between:■ 1. Arterial and capillary blood fl ow.
■ 2. Arterial and venous blood fl ow.
■ 3. Arterial and arteriole blood fl ow.
■ 4. Capillary and venous blood fl ow.
18.
Which of the following lipid abnormalities is a risk factor for the development of atherosclerosis and peripheral vascular disease?■ 1. Low concentration of triglycerides.
■ 2. High levels of high-density lipid (HDL) cholesterol.
■ 3. High levels of low-density lipid (LDL) cholesterol.
■ 4. Low levels of LDL cholesterol.
19.
When assessing an individual with periph- eral vascular disease, which clinical manifestation would indicate complete arterial obstruction in the lower left leg?■ 1. Aching pain in the left calf.
■ 2. Burning pain in the left calf.
■ 3. Numbness and tingling in the left leg.
■ 4. Coldness of the left foot and ankle.
20.
One goal of care for a client with PVD is to decrease anxiety, so as to decrease or prevent vaso- constriction of the:■ 1. Arteries.
■ 2. Capillaries.
■ 3. Lymphatics.
■ 4. Veins.
21.
A 70-year-old male with the diagnosis of claudication has been hospitalized for an evaluation of his increasingly impaired mobility and com- plaints of pain. The client tells the nurse that he can no longer walk a block without having severe pain in his left calf and foot. Based on these data, which nursing diagnosis would be most appropriate for this client?■ 1. Activity intolerance related to decreased blood supply and pain.
■ 2. Self-care defi cit related to increased leg pain.
■ 3. Ineffective coping related to chronic pain.
■ 4. Impaired skin integrity related to poor circu- lation.
22.
A client with peripheral vascular disease returns to the surgical care unit after having femoral- popliteal bypass grafting. Indicate in which order the nurse should conduct assessment of this client.2. Peripheral pulses.
3. Urine output.
4. Incision site.
1. Postoperative pain.
23.
A client with a history of heart failure has bilateral +4 edema of her right ankle that extends up to midcalf. She is sitting out of bed and has her legs in a dependent position. Which of the following goals is the priority?■ 1. Decrease venous congestion.
■ 2. Maintain normal respirations.
■ 3. Maintain body temperature.
■ 4. Prevent injury to lower extremities.
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30.
A client with peripheral vascular disease has bypass surgery. The primary goal of the plan of care after surgery is to:■ 1. Maintain circulation.
■ 2. Prevent infection.
■ 3. Relieve pain.
■ 4. Provide education.
31.
The nurse is instructing a client who is at risk for peripheral vascular disease how to use knee length elastic stockings (support hose). The teaching plan should include which of the following? Check all that apply.■ 1. Apply the elastic stockings in the morning.
■ 2. Remove the stockings if swelling occurs.
■ 3. Apply the stockings while in bed.
■ 4. Once the stockings have been pulled over the calf, roll the remaining stocking down to make a cuff.
■ 5. Keep the stockings in place for 48 hours and reapply using a clean pair of stockings.
32.
A client is scheduled to undergo right axillary-to-axillary artery bypass surgery. Which of the following interventions is most important for the nurse to implement in the preoperative period?■ 1. Assess the temperature in the affected arm.
■ 2. Monitor the radial pulse in the affected arm.
■ 3. Protect the extremity from cold.
■ 4. Avoid using the arm for a venipuncture.