Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 37 - Vascular Disorders
1. When discussing risk factor modification for a 63-year-old patient who has a 5-
cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which
patient risk factor?
A. Male gender
B. Turner syndrome
C. Abdominal trauma history
D. Uncontrolled hypertension
Answer: D
Explanation: All of the factors contribute to the patients risk, but only hypertension can
potentially be modified to decrease the patients risk for further expansion of the aneurysm.
2. A patient has a 6-cm thoracic aortic aneurysm that was discovered during a
routine chest x-ray. When obtaining an admission history from the patient, it
will be most important for the nurse to ask about
A. low back pain.
B. trouble swallowing.
C. abdominal tenderness.
D. changes in bowel habits.
Answer: B
Explanation: Difficulty swallowing may occur with a thoracic aneurysm because of pressure
on the esophagus. The other symptoms will be important to assess for in patients with
abdominal aortic aneurysms.
3. Several hours after an open surgical repair of an abdominal aortic aneurysm, the
UAP reports to the nurse that urinary output for the past 2 hours has been 40
mL. The nurse notifies the health care provider and anticipates an order for a(n)
A. hemoglobin count.
B. additional antibiotic.
C. decrease in IV infusion rate.
D. blood urea nitrogen (BUN) level.
Answer: D
Explanation: The decreased urine output suggests decreased renal perfusion, and monitoring
of renal function is needed. There is no indication that infection is a concern, so antibiotic
,therapy and a WBC count are not needed. The IV rate may be increased because
hypovolemia may be contributing to the patients decreased urinary output.
4. A patient in the outpatient clinic has a new diagnosis of peripheral artery disease
(PAD). Which group of medications will the nurse plan to include when
providing patient teaching about PAD management?
A. Statins
B. Antibiotics
C. Thrombolytics
D. Anticoagulants
Answer: A
Explanation: Current research indicates that statin use by patients with PAD improves
multiple outcomes. There is no research that supports the use of the other medication
categories in PAD.
5. A 73-year-old patient with chronic atrial fibrillation develops sudden severe
pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify
the health care provider and immediately
A. apply a compression stocking to the leg.
B. elevate the leg above the level of the heart.
C. assist the patient in gently exercising the leg.
D. keep the patient in bed in the supine position.
Answer: D
Explanation: The patients history and clinical manifestations are consistent with acute arterial
occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize
ischemic damage until circulation can be restored. Elevating the leg or applying an elastic
wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand
for the tissues of the leg.
6. A patient at the clinic says, I have always taken a walk after dinner, but lately
my leg cramps and hurts after just a few minutes of starting. The pain goes away
after I stop walking, though. The nurse should
A. check for the presence of tortuous veins bilaterally on the legs.
B. ask about any skin color changes that occur in response to cold.
C. assess for unilateral swelling, redness, and tenderness of either leg.
D. assess for the presence of the dorsalis pedis and posterior tibial pulses.
Answer: D
,Explanation: The nurse should assess for other clinical manifestations of peripheral arterial
disease in a patient who describes intermittent claudication. Changes in skin color that occur
in response to cold are consistent with Raynauds phenomenon. Tortuous veins on the legs
suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness indicate venous
thromboembolism (VTE).
7. The nurse performing an assessment with a patient who has chronic peripheral
artery disease (PAD) of the legs and an ulcer on the right second toe would
expect to find
A. dilated superficial veins.
B. swollen, dry, scaly ankles.
C. prolonged capillary refill in all the toes.
D. a serosanguineous drainage from the ulcer.
Answer: C
Explanation: Capillary refill is prolonged in PAD because of the slower and decreased blood
flow to the periphery. The other listed clinical manifestations are consistent with chronic
venous disease.
8. When evaluating the discharge teaching for a patient with chronic peripheral
artery disease (PAD), the nurse determines a need for further instruction when
the patient says, I will
A. have to buy some loose clothes that do not bind across my legs or waist.
B. use a heating pad on my feet at night to increase the circulation and warmth in my
feet.
C. change my position every hour and avoid long periods of sitting with my legs
crossed.
D. walk to the point of pain, rest, and walk again until the pain returns for at least 30
minutes 3 times a week.
Answer: B
Explanation: Because the patient has impaired circulation and sensation to the feet, the use of
a heating pad could lead to burns. The other patient statements are correct and indicate that
teaching has been successful.
9. After teaching a patient with newly diagnosed Raynauds phenomenon about how
to manage the condition, which action by the patient demonstrates that the
teaching has been effective?
A. The patient exercises indoors during the winter months.
B. The patient places the hands in hot water when they turn pale.
, C. The patient takes pseudoephedrine (Sudafed) for cold symptoms.
D. The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).
Answer: A
Explanation: Patients should avoid temperature extremes by exercising indoors when it is
cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the
hands. Pseudoephedrine is a vasoconstrictor, and should be avoided. There is no reason to
avoid taking NSAIDs with Raynauds phenomenon.
10. The health care provider has prescribed bed rest with the feet elevated for a
patient admitted to the hospital with venous thromboembolism. Which action by
the nurse to elevate the patients feet is best?
A. The patient is placed in the Trendelenburg position.
B. Two pillows are positioned under the affected leg.
C. The bed is elevated at the knee and pillows are placed under the feet.
D. One pillow is placed under the thighs and two pillows are placed under the lower
legs.
Answer: D
Explanation: The purpose of elevating the feet is to enhance venous flow from the feet to the
right atrium, which is best accomplished by placing two pillows under the feet and one under
the thighs. Placing the patient in the Trendelenburg position will lower the head below heart
level, which is not indicated for this patient. Placing pillows under the calf or elevating the
bed at the knee may cause blood stasis at the calf level.
11. The health care provider prescribes an infusion of heparin (Hep-Lock) and daily
partial thromboplastin time (PTT) testing for a patient with venous
thromboembolism (VTE). The nurse will plan to
A. decrease the infusion when the PTT value is 65 seconds.
B. avoid giving any IM medications to prevent localized bleeding.
C. monitor posterior tibial and dorsalis pedis pulses with the Doppler.
D. have vitamin K available in case reversal of the heparin is needed.
Answer: B
Explanation: IM injections are avoided in patients receiving anticoagulation. A PTT of 65
seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality
is not affected by VTE.
12. A patient with a venous thromboembolism (VTE) is started on enoxaparin
(Lovenox) and warfarin (Coumadin). The patient asks the nurse why two
Chapter 37 - Vascular Disorders
1. When discussing risk factor modification for a 63-year-old patient who has a 5-
cm abdominal aortic aneurysm, the nurse will focus discharge teaching on which
patient risk factor?
A. Male gender
B. Turner syndrome
C. Abdominal trauma history
D. Uncontrolled hypertension
Answer: D
Explanation: All of the factors contribute to the patients risk, but only hypertension can
potentially be modified to decrease the patients risk for further expansion of the aneurysm.
2. A patient has a 6-cm thoracic aortic aneurysm that was discovered during a
routine chest x-ray. When obtaining an admission history from the patient, it
will be most important for the nurse to ask about
A. low back pain.
B. trouble swallowing.
C. abdominal tenderness.
D. changes in bowel habits.
Answer: B
Explanation: Difficulty swallowing may occur with a thoracic aneurysm because of pressure
on the esophagus. The other symptoms will be important to assess for in patients with
abdominal aortic aneurysms.
3. Several hours after an open surgical repair of an abdominal aortic aneurysm, the
UAP reports to the nurse that urinary output for the past 2 hours has been 40
mL. The nurse notifies the health care provider and anticipates an order for a(n)
A. hemoglobin count.
B. additional antibiotic.
C. decrease in IV infusion rate.
D. blood urea nitrogen (BUN) level.
Answer: D
Explanation: The decreased urine output suggests decreased renal perfusion, and monitoring
of renal function is needed. There is no indication that infection is a concern, so antibiotic
,therapy and a WBC count are not needed. The IV rate may be increased because
hypovolemia may be contributing to the patients decreased urinary output.
4. A patient in the outpatient clinic has a new diagnosis of peripheral artery disease
(PAD). Which group of medications will the nurse plan to include when
providing patient teaching about PAD management?
A. Statins
B. Antibiotics
C. Thrombolytics
D. Anticoagulants
Answer: A
Explanation: Current research indicates that statin use by patients with PAD improves
multiple outcomes. There is no research that supports the use of the other medication
categories in PAD.
5. A 73-year-old patient with chronic atrial fibrillation develops sudden severe
pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify
the health care provider and immediately
A. apply a compression stocking to the leg.
B. elevate the leg above the level of the heart.
C. assist the patient in gently exercising the leg.
D. keep the patient in bed in the supine position.
Answer: D
Explanation: The patients history and clinical manifestations are consistent with acute arterial
occlusion, and resting the leg will decrease the oxygen demand of the tissues and minimize
ischemic damage until circulation can be restored. Elevating the leg or applying an elastic
wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand
for the tissues of the leg.
6. A patient at the clinic says, I have always taken a walk after dinner, but lately
my leg cramps and hurts after just a few minutes of starting. The pain goes away
after I stop walking, though. The nurse should
A. check for the presence of tortuous veins bilaterally on the legs.
B. ask about any skin color changes that occur in response to cold.
C. assess for unilateral swelling, redness, and tenderness of either leg.
D. assess for the presence of the dorsalis pedis and posterior tibial pulses.
Answer: D
,Explanation: The nurse should assess for other clinical manifestations of peripheral arterial
disease in a patient who describes intermittent claudication. Changes in skin color that occur
in response to cold are consistent with Raynauds phenomenon. Tortuous veins on the legs
suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness indicate venous
thromboembolism (VTE).
7. The nurse performing an assessment with a patient who has chronic peripheral
artery disease (PAD) of the legs and an ulcer on the right second toe would
expect to find
A. dilated superficial veins.
B. swollen, dry, scaly ankles.
C. prolonged capillary refill in all the toes.
D. a serosanguineous drainage from the ulcer.
Answer: C
Explanation: Capillary refill is prolonged in PAD because of the slower and decreased blood
flow to the periphery. The other listed clinical manifestations are consistent with chronic
venous disease.
8. When evaluating the discharge teaching for a patient with chronic peripheral
artery disease (PAD), the nurse determines a need for further instruction when
the patient says, I will
A. have to buy some loose clothes that do not bind across my legs or waist.
B. use a heating pad on my feet at night to increase the circulation and warmth in my
feet.
C. change my position every hour and avoid long periods of sitting with my legs
crossed.
D. walk to the point of pain, rest, and walk again until the pain returns for at least 30
minutes 3 times a week.
Answer: B
Explanation: Because the patient has impaired circulation and sensation to the feet, the use of
a heating pad could lead to burns. The other patient statements are correct and indicate that
teaching has been successful.
9. After teaching a patient with newly diagnosed Raynauds phenomenon about how
to manage the condition, which action by the patient demonstrates that the
teaching has been effective?
A. The patient exercises indoors during the winter months.
B. The patient places the hands in hot water when they turn pale.
, C. The patient takes pseudoephedrine (Sudafed) for cold symptoms.
D. The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).
Answer: A
Explanation: Patients should avoid temperature extremes by exercising indoors when it is
cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the
hands. Pseudoephedrine is a vasoconstrictor, and should be avoided. There is no reason to
avoid taking NSAIDs with Raynauds phenomenon.
10. The health care provider has prescribed bed rest with the feet elevated for a
patient admitted to the hospital with venous thromboembolism. Which action by
the nurse to elevate the patients feet is best?
A. The patient is placed in the Trendelenburg position.
B. Two pillows are positioned under the affected leg.
C. The bed is elevated at the knee and pillows are placed under the feet.
D. One pillow is placed under the thighs and two pillows are placed under the lower
legs.
Answer: D
Explanation: The purpose of elevating the feet is to enhance venous flow from the feet to the
right atrium, which is best accomplished by placing two pillows under the feet and one under
the thighs. Placing the patient in the Trendelenburg position will lower the head below heart
level, which is not indicated for this patient. Placing pillows under the calf or elevating the
bed at the knee may cause blood stasis at the calf level.
11. The health care provider prescribes an infusion of heparin (Hep-Lock) and daily
partial thromboplastin time (PTT) testing for a patient with venous
thromboembolism (VTE). The nurse will plan to
A. decrease the infusion when the PTT value is 65 seconds.
B. avoid giving any IM medications to prevent localized bleeding.
C. monitor posterior tibial and dorsalis pedis pulses with the Doppler.
D. have vitamin K available in case reversal of the heparin is needed.
Answer: B
Explanation: IM injections are avoided in patients receiving anticoagulation. A PTT of 65
seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality
is not affected by VTE.
12. A patient with a venous thromboembolism (VTE) is started on enoxaparin
(Lovenox) and warfarin (Coumadin). The patient asks the nurse why two
