Abdominal Aortic Aneurysm

Description
An aortic aneurysm is an abnormal dilation of the arterial wall caused by localized
weakness and stretching in the medial layer or wall of an artery.
The aneurysm can be located anywhere along the abdominal aorta.
The goal of treatment is to limit the progression of the disease by modifying risk
factors, controlling the BP to prevent strain on the aneurysm, recognizing symptoms
early, and preventing rupture.

Assessment

1. Promine
nt,

pulsating () mass in abdomen, at or above the umbilicus

2. Systolic bruit over the aorta
3. Tenderness on deep palpation
4. Abdominal or lower back pain
Diagnostic Evaluation
1. Chest radiograph, angiogram, transesophageal echocardiography, and magnetic
resonance imaging(MRI).
2. Duplex ultrasonography or computed tomography (CT)

Primary Nursing Diagnosis

Risk for fluid volume deficit related to hemorrhage
Other Diagnoses that may occur in Nursing Care Plans For Abdominal Aortic
Aneurysm
Acute pain related to surgical tissue trauma
Anxiety related to threat to health status
Decreased cardiac output related to:

changes in intravascular volume

increased systemic vascular resistance
third-space fluid shift
Deficient knowledge (preoperative and postoperative care) related to newly identified
need for aortic surgery Ineffective breathing pattern related to:
effects of general anesthesia
endotracheal intubation
presence of an abdominal incision

Medical Management
Medical or surgical treatment depends on the type of aneurysm. For a rupture aneurysm,
prognosis is poor and surgery is performed immediately. When surgery can be
delayed, medical measures include:
Strict control of blood pressure and reduction in pulsatile (flow.
Systolic pressure maintained at 100 to 120 mm Hg with antihypertensive drugs, such
as nitroprusside.
Pulsatile flow reduced by medications that reduce cardiac contractility, such as
propanolol.
Surgical Management
Removal of the aneurysm and restoration of vascular continuity with a graft
(resection and bypass graft or endovascular grafting) is the goal of surgery and the
treatment of choice for abdominal aortic aneurysms larger than 5.5 cm (2 inches) in
diameter or those that are enlarging. Intensive monitoring in the critical care unit is
required.
Nonsurgical Intervention
1. Modify risk factors.
2. Instruct the client regarding the procedure for monitoring BP.
3. Instruct the client on the importance of regular physician visits to follow the size of
the aneurysm.
4. Instruct the client that if severe back or abdominal pain or fullness, soreness over the
umbilicus, sudden development of discoloration in the extremities, or a persistent
elevation of BP occurs to notify the physician immediately.
5. Instruct the client with a thoracic aneurysm to report immediately the occurrence of
chest or back pain, shortness of breath, difficulty swallowing, or hoarseness.
Pharmacologic Highlights
1. 1-10 mg IV of opioid analgesic (morphine) to relieve surgical pain.
2. 50100 mcg IV of opioid analgesic (Fentanyl) to relieve surgical pain.
3. Antihypertensives and/or diuretics for rising BP may stress graft suture lines.

4. 80-400 mg/day in divide doses of Beta blocker (propanolol) to use in people with
small aneurysms without risk for rupture; decreases rate of AAA expansion

Nursing Intervention
1. Monitor vital signs.
2. Assess risk factors for the arterial disease process.
3. Obtain information regarding back or abdominal pain.
4. Question the client regarding the sensation of palpation in the abdomen.
5. Inspect the skin for the presence of vascular disease or breakdown.
6. Check peripheral circulation, including pulses,temperature, and color.
7. Observe for signs of rupture.
8. Note any tenderness over the abdomen.
9. Monitor for abdominal distention.

Documentation Guidelines
Location,intensity,and frequency of pain,and the factors that relieve pain
Appearance of abdominal wound (color,temperature,intactness,drainage)
Evidence of stability of vital signs,hydration status,bowel sounds,electrolytes
Presence of complications: Hypotension, hypertension, cardiac dysrhythmias, low
urine out- put,thrombophlebitis,infection,graft occlusion,changes in
consciousness,aneurysm rupture, excessive anxiety,poor wound healing
Discharge and Home Healthcare Guidelines
1. Wound care. Explain the need to keep the surgical wound clean and dry. Teach the
patient to observe the wound and report to the physician any increased
swelling,redness,drainage,odor,or separation of the wound edges. Also instruct the
patient to notify the physician if a fever develops.
2. Activity restriction. Instruct the patient to lift nothing heavier than 5 pounds for about
6 to 12 weeks and to avoid driving until her or his physician permits. Braking while
driving may increase intra-abdominal pressure and disrupt the suture line. Most
surgeons temporarily discourage activities that require pulling, pushing, or stretching
activities such as vacuuming,changing sheets,playing tennis and golf,mowing
grass,and chopping wood.
3. Smoking cessation. Encourage the patient to stop smoking and to attend smoking
cessation classes.
4. Complications following surgery. Discuss with the patient the possibility of clot
formation or graft blockage.
5. Complications for patients not requiring surgery. Compliance with the regime of
monitoring the size of the aneurysm by computed tomography over time is essential.
The patient needs to understand the prescribed medication to control hypertension.
Advise the patient to report abdominal fullness or back pain,which may indicate a
pending rupture.
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Q.1) Which of the following signs and symptoms usually signifies rapid expansion and
impending rupture of an abdominal aortic aneurysm?
A. Abdominal pain.
B. Absent pedal pulses.
C. Chest pain.
D. Lower back pain.
Explanation
Lower back pain results from expansion of the aneurysm. The expansion applies pressure in
the abdomen, and the pain is referred to the lower back. Abdominal pain is the most common
symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation
and would occur after a ruptured aneurysm or in peripheral vascular disease. Chest pain
usually is associated with coronary artery or pulmonary disease.
Q.2) With which of the following disorders is jugular vein distention most prominent?
A. Abdominal aortic aneurysm
B. Heart failure
C. Myocardial infarction
D. Pneumothorax
Explanation
Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart
to pump. Jugular vein distention isnt a symptom of abdominal aortic aneurysm or
pneumothorax. An MI, if severe enough, can progress to heart failure; however, in and of
itself, an MI doesnt cause jugular vein distention.
The jugular veins are veins that bring deoxygenated blood from the head back to the heart via
the superior vena cava.
Q.3) What is the most common cause of abdominal aortic aneurysm?
A. Atherosclerosis
B. DM
C. HPN
D. Syphilis
Explanation
Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the
wall of the vessel and weaken it, causing an aneurysm. Although the other conditions are
related to the development of an aneurysm, none is a direct cause.
Q.4) In which of the following areas is an abdominal aortic aneurysm most commonly
located?
A. Distal to the iliac arteries
B. Distal to the renal arteries
C. Adjacent to the aortic branch
D. Proximal to the renal arteries
Explanation
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The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the
vessel isnt surrounded by stable structures, unlike the proximal portion of the aorta. Distal to
the iliac arteries, the vessel is again surrounded by stable vasculature, making this an
uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends
into the thoracic (descending) aorta.
Q.5) A pulsating abdominal mass usually indicates which of the following conditions?
A. Abdominal aortic aneurysm
B. Enlarged spleen
C. Gastic distention
D. Gastritis
Explanation
The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating
an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding,
however, can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastic
distention cause pulsation.
Q.6) What is the most common symptom in a client with abdominal aortic aneurysm?
A. Abdominal pain
B. Diaphoresis
C. Headache
D. Upper back pain
Explanation
Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of
normal circulation in the abdominal region. Lower back pain, not upper, is a common
symptom, usually signifying expansion and impending rupture of the aneurysm. Headache
and diaphoresis arent associated with abdominal aortic aneurysm.
Q.7) Which of the following symptoms usually signifies rapid expansion and impending
rupture of an abdominal aortic aneurysm?
A. Abdominal pain
B. Absent pedal pulses
C. Angina
D. Lower back pain
Explanation
Lower back pain results from expansion of the aneurysm. The expansion applies pressure in
the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is most
common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no
circulation and would occur after a ruptured aneurysm or in peripheral vascular disease.
Angina is associated with atherosclerosis of the coronary arteries.
Q.8) What is the definitive test used to diagnose an abdominal aortic aneurysm?
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A. Abdominal X-ray
B. Arteriogram
C. CT scan
D. Ultrasound

Q.9) Which of the following complications is of greatest concern when caring for a
preoperative abdominal aneurysm client?
A. HPN
B. Aneurysm rupture
C. Cardiac arrythmias
D. Diminished pedal pulses

Q.10) Which of the following blood vessel layers may be damaged in a client with an
aneurysm?
A. Externa
B. Interna
C. Media
D. Interna and Media
The factor common to all types of aneurysms is a damaged media. The media has more
smooth muscle and less elastic fibers, so its more capable of vasoconstriction and
vasodilation. The interna and externa are generally no damaged in an aneurysm.
Q.11) When assessing a client for an abdominal aortic aneurysm, which area of the abdomen
is most commonly palpated?
A. Right upper quadrant
B. Directly over the umbilicus
C. Middle lower abdomen to the left of the midline
D. Midline lower abdomen to the right of the midline
The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for
palpation.
Q.16) A client is admitted with suspected abdominal aortic aneurysm (AAA). A common
complaint of the client with an abdominal aortic aneurysm is:
A. Loss of sensation in the lower extremities
B. Back pain that lessens when standing
C. Decreased urinary output
D. Pulsations in the periumbilical area
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Q.17) Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced
with a graft. When she arrives in the RR she is still in shock. The nurses priority should be :
A. placing her in a trendeleburg position
B. putting several warm blankets on her
C. monitoring her hourly urine output
D. assessing her VS especially her RR

Q.19) A patient comes to the emergency department with abdominal pain. Work-up reveals
the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following
actions should the nurse expect?
A. The patient will be admitted to the medicine unit for observation and medication.
B. The patient will be admitted to the day surgery unit for sclerotherapy.
C. The patient will be admitted to the surgical unit and resection will be scheduled.
D. The patient will be discharged home to follow-up with his cardiologist in 24 hours.

Q.20) A 76 year old man enters the ER with complaints of back pain and feeling fatigued.
Upon examination, his blood pressure is 190/100, pulse is 118, and hematocrit and
hemoglobin are both low. The nurse palpates the abdomen which is soft, non-tender and
auscultates an abdominal pulse. The most likely diagnosis is:
A. Buergers disease
B. CHF
C. Secondary hypertension
D. Aneurysm

Q.21) An adult client has continued slow bleeding from the graft after repair of an abdominal
aortic aneurysm. Because of the clients unstable condition, he is in the intensive care unit
where visitors are limited to the family. The client insists on having a visit from a medicine
man whom the family visits regularly. How should the nurse interpret this request?
A. The principle of justice prohibits giving one client a privilege that other clients are not
permitted.
B. Faith healers do not meet the standards for clergy exemption from visitation rules.
C. Medicine men are not approved by the hospital as legitimate health care providers.
D. Provision of holistic care requires that the clients belief system is honored.

A client is admitted to the health care facility for treatment of an abdominal aortic aneurysm.
When planning this client's care, the nurse formulates interventions with which goal in mind?
Stabilizing the heart rate and blood pressure and easing anxiety
RATIONALES: For a client with an aneurysm, nursing interventions focus on stabilizing the
heart rate and blood pressure, to avoid aneurysm rupture. Easing anxiety also is important
because anxiety and increased stimulation may speed the heart rate and boost blood pressure,
precipitating aneurysm rupture. Typically, the client with an abdominal aortic aneurysm is
hypertensive, so the nurse should take measures to lower the blood pressure, such as
administering antihypertensive agents, as prescribed, to prevent aneurysm rupture. To sustain
major organ perfusion, a mean arterial pressure of at least 60 mm Hg should be maintained.
Although mobility must be assessed individually, most clients need bed rest initially when
attempting to gain stability.
A client is recovering from surgical repair of a dissecting aortic aneurysm. The nurse should
evaluate the client for signs of bleeding or recurring dissection. These signs include:
hypotension and tachycardia.
RATIONALES: When caring for a client recovering from surgical repair of a dissecting aortic
aneurysm, the nurse must monitor for hypotension with reflex tachycardia, decreased urine
output, and unequal or absent peripheral pulses all potential signs of bleeding or recurring
dissection. Hematuria, increased urine output, and bradycardia aren't signs of bleeding from
aneurysm repair or recurring dissection.
Which of the following complications is most common after an abdominal aortic aneurysm
resection?
Hemorrhage and shock
RATIONALES: Hemorrhage and shock are the most common complications after abdominal
aortic aneurysm resection. Renal failure can occur as a result of shock or from injury to the
renal arteries during surgery. Graft occlusion and enteric fistula formation are rare
complications of abdominal aortic aneurysm repair.
The most common site of aneurysm formation is in the:
abdominal aorta, just below the renal arteries.
RATIONALES: About 75% of aneurysms occur in the abdominal aorta, just below the renal
arteries (Debakey type I aneurysms). Debakey type II aneurysms occur in the ascending aorta
and aortic arch. Debakey type III aneurysms are found in the descending aorta.
What is the most common cause of abdominal aortic aneurysm?
Atherosclerosis
Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the
wall of the vessel and weaken it, causing an aneurysm. Although the other conditions are
related to the development of an aneurysm, none is a direct cause.
In which of the following areas is an abdominal aortic aneurysm most commonly located?
Distal to the renal arteries
8

The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the
vessel isnt surrounded by stable structures, unlike the proximal portion of the aorta. Distal to
the iliac arteries, the vessel is again surrounded by stable vasculature, making this an
uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into
the thoracic (descending) aorta.
A pulsating abdominal mass usually indicates which of the following conditions?
Abdominal aortic aneurysm
The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating
an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however,
can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastic distention
cause pulsation.
What is the most common symptom in a client with abdominal aortic aneurysm?
Abdominal pain
Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of
normal circulation in the abdominal region. Lower back pain, not upper, is a common
symptom, usually signifying expansion and impending rupture of the aneurysm. Headache
and diaphoresis arent associated with abdominal aortic aneurysm.
Which of the following symptoms usually signifies rapid expansion and impending rupture of
an abdominal aortic aneurysm?
Lower back pain
Lower back pain results from expansion of the aneurysm. The expansion applies pressure in
the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is most
common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no
circulation and would occur after a ruptured aneurysm or in peripheral vascular disease.
Angina is associated with atherosclerosis of the coronary arteries.
What is the definitive test used to diagnose an abdominal aortic aneurysm?
Arteriogram
An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates
the vessels and any abnormalities. An abdominal aneurysm would only be visible on an X-ray
if it were calcified. CT scan and ultrasound dont give a direct view of the vessels and dont
yield as accurate a diagnosis as the arteriogram.
Which of the following complications is of greatest concern when caring for a preoperative
abdominal aneurysm client?
Aneurysm rupture
Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the
nurse caring for this type of client. Hypertension should be avoided and controlled because it
can cause the weakened vessel to rupture. Diminished pedal pulses, a sign of poor circulation
to the lower extremities, are associated with an aneurysm but isnt life threatening. Cardiac
arrhythmias arent directly linked to an aneurysm.
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Which of the following blood vessel layers may be damaged in a client with an aneurysm?
Media
The factor common to all types of aneurysms is a damaged media. The media has more
smooth muscle and less elastic fibers, so its more capable of vasoconstriction and
vasodilation. The interna and externa are generally no damaged in an aneurysm.
When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most
commonly palpated?
Middle lower abdomen to the left of the midline
The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for
palpation.
Which of the following conditions is linked to more than 50% of clients with abdominal
aortic aneurysms?
HPN
Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an
aneurysm to occur. Atherosclerotic changes can occur with peripheral vascular diseases and
are linked to aneurysms, but the link isnt as strong as it is with hypertension. Only 1% of
clients with syphilis experience an aneurysm. Diabetes mellitus doesnt have direct link to
aneurysm.
Which of the following sounds is distinctly heard on auscultation over the abdominal region
of an abdominal aortic aneurysm client?
Bruit
A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion.
Crackles are indicative of fluid in the lungs. Dullness is heard over solid organs, such as the
liver. Friction rubs indicate inflammation of the peritoneal surface.
Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
Severe lower back pain, decreased BP, decreased RBC, increased WBC
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied
within the abdominal cavity. When rupture occurs, the pain is constant because it cant be
alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood.
After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood
pressure wouldnt increase. For the same reason, the RBC count is decreased not increase.
The WBC count increases as cells migrate to the site of injury.
Which of the following complications of an abdominal aortic repair is indicated by detection
of a hematoma in the perineal area?
Retroperitoneal rupture at the repair site
Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal
area. This rupture is most commonly caused by leakage at the repair site. A hernia doesnt
cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid
10

expansion of the aneurysm, a hematoma wont form.

Which hereditary disease is most closely linked to aneurysm?
Marfan's syndrome
Marfans syndrome results in the degeneration of the elastic fibers of the aortic media.
Therefore, clients with the syndrome are more likely to develop an aortic aneurysm. Although
cystic fibrosis is hereditary, it hasnt been linked to aneurysms. Lupus erythematosus isnt
hereditary. Myocardial infarction is neither hereditary nor a disease.
Which of the following treatments is the definitive one for a ruptured aneurysm?
Surgical intervention
When the vessel ruptures, surgery is the only intervention that can repair it. Administration of
antihypertensive medications and beta-adrenergic blockers can help control hypertension,
reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm.
A nurse is assessing a client with an abdominal aortic aneurysm. Which of the following
assessment findings by the nurse is probably unrelated to the aneurysm?
Hyperactive bowel sounds in that area
Not all clients with abdominal aortic aneurysms exhibit symptoms. Those who do describe a
feeling of the heart beating in the abdomen when supine or be able to feel the mass
throbbing. A pulsatile mass may be palpated in the middle and upper abdomen. A systolic
bruit may be auscultated over the mass. Hyperactive bowel sounds are not related specifically
to an abdominal aortic aneurysm.
Which of the following treatments is the definitive one for a ruptured aneurysm?
Surgical intervention
Which hereditary disease is most closely linked to aneurysm?
Marfan's syndrome
Marfans syndrome results in the degeneration of the elastic fibers of the aortic media.
Therefore, clients with the syndrome are more likely to develop an aortic aneurysm. Although
cystic fibrosis is hereditary, it hasnt been linked to aneurysms. Lupus erythematosus isnt
hereditary. Myocardial infarction is neither hereditary nor a disease.
Which of the following complications of an abdominal aortic repair is indicated by detection
of a hematoma in the perineal area?
Retroperitoneal rupture at the repair site
Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal
area. This rupture is most commonly caused by leakage at the repair site. A hernia doesnt
cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid
expansion of the aneurysm, a hematoma wont form.
Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
Severe lower back pain, decreased BP, decreased RBC, increased WBC
11

Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied
within the abdominal cavity. When rupture occurs, the pain is constant because it cant be
alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood.
After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood
pressure wouldnt increase. For the same reason, the RBC count is decreased not increase.
The WBC count increases as cells migrate to the site of injury.
Which of the following sounds is distinctly heard on auscultation over the abdominal region
of an abdominal aortic aneurysm client?
Bruit
A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion.
Crackles are indicative of fluid in the lungs. Dullness is heard over solid organs, such as the
liver. Friction rubs indicate inflammation of the peritoneal surface.
Which of the following conditions is linked to more than 50% of clients with abdominal
aortic aneurysms?
HPN
Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an
aneurysm to occur. Atherosclerotic changes can occur with peripheral vascular diseases and
are linked to aneurysms, but the link isnt as strong as it is with hypertension. Only 1% of
clients with syphilis experience an aneurysm. Diabetes mellitus doesnt have direct link to
aneurysm.

A client is hospitalized for repair of an abdominal aortic

aneurysm. The nurse must be alert for signs and symptoms
of aneurysm rupture and thus looks for which of the
following?
a) Slow heart rate and high blood pressure
b) Constant, intense back pain and falling blood
pressure
c) Constant, intense headache and falling blood pressure
d) Higher than normal blood pressure and falling
hematocrit
Indications of a rupturing abdominal aortic aneurysm include constant, intense back pain; falling
blood pressure; and decreasing hematocrit.

When caring for a client with a diagnosis of aortic

aneurysm scheduled for surgery, what would be most
important for the nurse to monitor?
a) Level of consciousness, characteristics of pain,
and signs of hemorrhage or dissection
b) BP, pulse, respirations, and signs of hemorrhage or
dissection
c) Cultural needs, characteristics of pain, and signs of
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hemorrhage or dissection
d) Intake and output, nutrition level, respirations, and
characteristics of pain
The nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and
characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional
levels, and cultural needs are important but not the most important assessments for the nurse to
make.

A physician admits a client to the health care facility

for treatment of an abdominal aortic aneurysm. When
planning this client's care, which goal should the nurse
keep in mind as she formulates interventions?
a) Increasing blood pressure and monitoring fluid intake
and output
b) Decreasing blood pressure and increasing mobility
c) Stabilizing heart rate and blood pressure and
easing anxiety
d) Increasing blood pressure and reducing mobility
For a client with an aneurysm, nursing interventions focus on preventing aneurysm rupture by
stabilizing heart rate and blood pressure. Easing anxiety also is important because anxiety and
increased stimulation may raise the heart rate and boost blood pressure, precipitating aneurysm
rupture. The client with an abdominal aortic aneurysm is typically hypertensive, so the nurse
should take measures to lower blood pressure, such as administering antihypertensive agents, as
ordered, to prevent aneurysm rupture. To sustain major organ perfusion, the client should maintain
a mean arterial pressure of at least 60 mm Hg. Although the nurse must assess each client's
mobility individually, most clients need bed rest when initially attempting to gain stability.

Which of the following is the most common site for a

dissecting aneurysm?
a) Cervical area
b) Sacral area
c) Thoracic area
d) Lumbar area
The thoracic area is the most common site for a dissecting aneurysm. About one-third of patients
with thoracic aneurysms die of rupture of the aneurysm.

Which sign or symptom suggests that a client's abdominal

aortic aneurysm is extending?
a) Elevated blood pressure and rapid respirations
b) Decreased pulse rate and blood pressure
c) Increased abdominal and back pain
d) Retrosternal back pain radiating to the left arm
Pain in the abdomen and back signify that the aneurysm is pressing downward on the lumbar
nerve root and is causing more pain. The pulse rate would increase with aneurysm extension.
13

Chest pain radiating down the arm would indicate myocardial infarction. Blood pressure would
decrease with aneurysm extension, and the respiratory rate may not be affected.

When caring for a client with a diagnosis of aortic

aneurysm scheduled for surgery, what would be most
important for the nurse to monitor?
a) Level of consciousness, characteristics of pain,
and signs of hemorrhage or dissection
b) Intake and output, nutrition level, respirations, and
characteristics of pain
c) Cultural needs, characteristics of pain, and signs of
hemorrhage or dissection
d) BP, pulse, respirations, and signs of hemorrhage or
dissection
The nurse monitors BP, pulse, hourly urine output, skin color, level of consciousness, and
characteristics of pain for signs of hemorrhage or dissection. Assessing respirations, nutritional
levels, and cultural needs are important but not the most important assessments for the nurse to
make.

A nurse should be prepared to manage complications

following abdominal aortic aneurysm resection. Which
complication is most common?
a) Renal failure
b) Graft occlusion
c) Hemorrhage and shock
d) Enteric fistula
Renal failure commonly occurs if clamping time is prolonged, cutting off the blood supply to the
kidneys. Hemorrhage and shock are the most common complications before abdominal aortic
aneurysm resection, and they occur if the aneurysm leaks or ruptures. Graft occlusion and enteric
fistula formation are rare complications of abdominal aortic aneurysm repair.

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