CH 31 - Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral

Chapter 31: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral
Circulation
A)
B)
A)
B)
A)
B)
1.The nurse is taking a health history on a new patient. The patient reports experiencing
pain in the left lower leg and foot when walking. This pain is relieved with rest. The
nurse notes that the left lower leg is slightly edematous and is hairless. What does the
nurse suspects that the patient may be experiencing?
Coronary artery disease
C) Arterial embolus
Intermittent claudication
D) Raynaud's disease
Ans: B
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Feedback:
A muscular, cramp-type pain in the extremities consistently reproduced with the same
degree of exercise or activity and relieved by rest is experienced by patients with
peripheral arterial insufficiency. Referred to as intermittent claudication, this pain is
caused by the inability of the arterial system to provide adequate blood flow to the
tissues in the face of increased demands for nutrients and oxygen during exercise. The
nurse would not suspect the patient has CAD, arterial embolus, or Raynaud's disease.
2.While assessing a patient the nurse notes that the patient's ankle-brachial index (ABI) of
the right leg is 0.40. The nurse is aware that this may indicate what?
Venous narrowing
C) Adequate peripheral circulation
Arterial narrowing
D) Inadequate coronary output
Ans: B
Difficulty: Difficult
Feedback:
ABI is used to assess the degree of stenosis of peripheral arteries. An ABI of less than
1.0 indicates possible claudication of the peripheral arteries. It does not indicate venous
narrowing, adequate peripheral circulation, or inadequate coronary output.
3.The nursing instructor is talking with the nursing students about peripheral arterial
occlusive disease (PACD). The instructor points out that when assessing a patient for
PACD the nurse would expect to find what?
Equal pulses in the extremities
C) Equal skin color between extremities
Unequal pulses between extremities D) Warm feet between extremities
Ans: B
Cognitive Level: Application
Integrated Process: Teaching/Learning
Feedback:
PACD assessment may manifest as unequal pulses between extremities, with the affected
leg cooler and paler than the unaffected leg. The nurse would not expect to find equal
pulses or skin color in the extremities or warm feet between extremities.
4.You are admitting a 32-year-old woman to your unit. The woman is to undergo major
surgery and will be on bed rest for at least 48 hours. While doing the admission
assessment the patient tells you she takes oral contraceptives. You know that this puts the
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A)
B)
A)
B)
A)
B)
A)
B)
patient at an increased risk of developing what?

Deep vein thrombosis
C) Raynaud's disease
D) Thoracic aneurysm
Ans: A
Feedback:
Oral contraceptive use increases blood coagulability; with bed rest, the patient may be at
increased risk of developing deep vein thrombosis. It does not put her at increased risk
for intermittent claudication, Raynaud's disease, or thoracic aneurysm.
5.A nursing student is writing a teaching plan for a patient with venous insufficiency. The
student covers measures to prevent complications from venous insufficiency. What is
one measure the student should include in the plan?
Avoiding tight-fitting socks
C) Sleeping with legs dependent
Reducing activity
D) Avoiding pressure stockings
Ans: A
Feedback:
Measures to take to prevent complications include avoiding tight fitting socks and panty
girdles, maintaining activities such as walking, sleeping with legs elevated, and using
pressure stockings. Not included in the teaching plan for venous insufficiency would be
reducing activity, sleeping with legs dependent, and avoiding pressure stockings.
6.You are caring for a patient with leg ulcers. You know that the most appropriate dressing
to apply on a patient with a superficial, uninfected leg ulcer would be what?
A hydrocolloid dressing
C) A dry sterile dressing
A dry gauze dressing
D) A hydrogen peroxide dressing
Ans: A
Feedback:
A hydrocolloid dressing maintains a moist environment and promotes granulation, but it
should not be used if the ulcer is infected. Dry sterile, dry gauze, or hydrogen peroxide
dressings should not be used, because they do not provide a moist wound environment.
7.You are caring for a patient who returned from the tropics 2 weeks ago. The patient has
been diagnosed with lymphangitis and is experiencing lymphedema. You are aware that
the lymphedema may be due to what?
Obstructed lymph vessels
C) Accumulation of blood
Sensitivity to antibiotics
D) Improper anticoagulant use
Ans: A
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Feedback:
Lymphedema is caused by accumulation of lymph in the tissues and may be a result of
obstructed lymph vessels. It is not caused by sensitivity to antibiotics, an accumulation
of blood or improper anticoagulant use.
A)
B)
C)
D)
A)
B)
8.A Community Health nurse is providing an educational event at the local high school.
The topic the nurse is speaking about is varicose veins. What would the nurse suggest as
a proactive preventative measure for varicose veins?
Sitting with crossed legs to promote relaxation.
Walking for several minutes every hour to promote circulation.
Elevating the legs when tired.
Wearing tight ankle socks to decrease edema
Ans: B
Feedback:
A proactive approach to preventing varicose veins would be to walk for several minutes
every hour to promote circulation. It is measurable, increases blood return to the heart,
and promotes overall wellness. Option A is incorrect; sitting with crossed legs may
promote relaxation but it is contraindicated for patients with, or at risk for, varicose
veins. Option C is good idea, but elevating the legs only helps blood passively return to
the heart and does not help maintain the competency of the valves in the veins. Option D
is incorrect; wearing tight ankle socks is contraindicated for patients with or at risk for
varicose veins; socks that are below the muscles of the calf do not promote venous
return, the socks simply capture the blood and promote venous stasis.
9.A patient comes to the walk-in clinic with complaints of pain in his foot following
stepping on a roofing nail a couple of days ago. The patient has a red streak running up
his leg. What would the nurse suspect?
Cellulitis
C) Elephantiasis
A minor superficial skin irritation.
D) Lymphangitis
Ans: D
Feedback:
Lymphangitis is an acute inflammation of the lymphatic channels. It arises most
commonly from a focus of infection in an extremity. Usually, the infectious organism is
hemolytic Streptococcus. The characteristic red streaks that extend up the arm or the leg
from an infected wound outline the course of the lymphatic vessels as they drain. Option
A is incorrect; cellulitis is caused by bacteria, which cause a generalized edema in the
subcutaneous tissues surrounding the affected area. Option B is incorrect; a minor
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superficial skin irritation would not present with red streaks in the lymphatic channels.
Option C is incorrect; elephantiasis is transmitted by mosquitoes that carry a parasitic
worm larvae; the parasites obstruct the lymphatic channels and results in gross
enlargement of the limbs.
10.You are the triage nurse in the emergency department (ED). A patient presents
complaining of pain and swelling in the right lower leg beginning last night along with
fever, chills, and sweating. The patient states that she hit my leg on the car door 4 or
five days ago and it has been sore ever since. The patient has a history of chronic
venous insufficiency. You suspect that this might be what?
A)
Thrombocytopenia
C) Cellulitis
B)
Arterial insufficiency
D) Phlebothrombosis
Ans: C
Feedback:
Cellulitis is the most common infectious cause of limb swelling. The signs and
symptoms include acute onset of swelling, localized redness, and pain; it is frequently
associated with systemic signs of fever, chills, and sweating. The patient may be able to
identify a trauma that accounts for the source of infection. Option A is incorrect;
thrombocytopenia is a loss or decrease in platelets and increases a patient's risk of
bleeding. Option B is incorrect; arterial insufficiency would present with pain related to
activity. Option D is incorrect but a good answer; phlebothrombosis presents with the
same signs and symptoms but is usually associated with mobility limitations and the
patient would not be able to identify a trauma that accounts for the source of infection.
11.A nurse in a long-term care facility is caring for an 83-year-old woman who has a history
of heart failure and peripheral arterial disease. At present the patient is unable to stand or
ambulate. What does the nurse know the patient is at significant risk for?
A)
Aoritis
C) Thoracic aortic aneurysm
B)
Deep vein thrombosis
D) Raynaud's disease
Ans: B
Feedback:
Although the exact cause of venous thrombosis remains unclear, three factors, known as
Virchow's triad, are believed to play a significant role in its development: stasis of blood
(venous stasis), vessel wall injury, and altered blood coagulation. In this woman's case,
she has venous stasis from immobility, vessel wall injury from peripheral arterial
disease, and altered blood coagulation from heart failure. Option A is incorrect; the cause
of aoritis is unknown but there is no direct connection to heart failure, peripheral arterial
disease, or mobility issues. Option C is incorrect; the greatest risk factors for thoracic
aortic aneurysm are atherosclerosis and hypertension; there is no direct connection to
heart failure, peripheral arterial disease, or mobility issues.
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Option D is incorrect; Raynaud's disease is a disorder that involves spasms of blood

vessels and again there is no direct connection to heart failure, peripheral arterial disease,
or mobility issues.
12.A nurse is admitting a 45-year-old man to the Medical Surgical unit. The patient has a
diagnosis of Buerger's disease. While taking the patient's health history he reveals that he
smokes about 2 packs of cigarettes a day, has a history of alcohol abuse, and does not
exercise. What would be the priority teaching for this patient?
A)
The lack of exercise, which is the identified cause of Buerger's disease.
B)
The likelihood that drinking alcohol and not exercising may cause his death in the
near future without a significant change in behavior.
C)
The cigarettes contain nicotine, which is a powerful vasoconstrictor and may cause
or aggravate Buerger's disease.
D)
The fact that alcohol suppresses the immune system, creates high glucose levels,
and may cause Buerger's disease.
Ans: C
Feedback:
Tobacco is powerful vasoconstrictor; its use with Buerger's disease is highly detrimental,
and patients are strongly advised to stop using tobacco. Symptoms are often relieved by
cessation of smoking along with all types of tobacco use. Option A is incorrect; the
identified cause of Buerger's disease is believed to be autoimmune in nature, resulting in
occlusion of distal vessels. Option B is incorrect; although drinking alcohol is not
suggested and exercise is encouraged for patients with Buerger's disease, there is no
evidence to suggest that drinking alcohol and not exercising dramatically increases the
patients' short-term risk of death. Option D is incorrect; alcohol is not a significant factor
or cause of Buerger's disease.
13.A nurse has written a plan of care for a 54-year-old man diagnosed with peripheral
arterial insufficiency. One of the nursing diagnoses in the care plan is altered peripheral
tissue perfusion related to compromised circulation. What is the most appropriate
intervention for this diagnosis?
A)
Elevating his legs and arms above his heart when resting
B)
Encourage the patient to engage in a moderate amount of exercise
C)
Encourage long periods of sitting or standing
D)
Discourage walking to decrease pain
Ans: B
Feedback:
The nursing diagnosis of altered peripheral tissue perfusion related to compromised
circulation, requires interventions that focus on improving circulation. Encouraging the
patient to engage in a moderate amount of exercise serves to improve circulation. Option
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A is incorrect; elevating his legs and arms above his heart when resting would be passive
and fails to promote circulation. Option C is incorrect; encouraging long periods of
sitting or standing would further compromise circulation. Option D is incorrect; the
nurse should encourage, not discourage, walking to increase circulation and decrease
pain.
14.You are caring for a 72-year-old patient who is in cardiac rehabilitation following openheart surgery. The patient has been walking on a regular basis for about a week and
walks for 15 minutes three times a day. The patient informs you that he is having a
cramp-like pain in the legs every time he walks and that the pain gets better when I
rest. What would you suspect is the problem with this patient?
A)
Glomerular nephritis
C) Venous insufficiency
B)
D) Vasculitis
Ans: B
Feedback:
Intermittent claudication presents as a muscular, cramp-type pain in the extremities
consistently reproduced with the same degree of exercise or activity and relieved by rest.
Patients with peripheral arterial insufficiency often complain of intermittent claudication
due to a lack of oxygen to muscle tissue. Option A is incorrect; glomerular nephritis is a
disorder of the kidneys and would not directly account for the pain. Option C is
incorrect; venous insufficiency presents as a disorder of venous blood reflux and does
not present with cramp-type pain with exercise. Option D is incorrect; vasculitis is an
inflammation of the blood vessels and presents with weakness, fever, and fatigue, but
does not present with cramp-type pain with exercise.
15.A nurse in the rehabilitation unit is caring for a 72-year-old patient who is in cardiac
rehabilitation following a myocardial infarction. The nurse's plan of care calls for the
patient to walk for 15 minutes three times a day. The patient asks why walking is good
for my heart. The nurse's best response is:
A)
The arteries in your legs constrict when you walk and allow the blood to move
faster and with more pressure on the tissue.
B)
Walking decreases the heart's pumping ability, and increases your heart rate and
blood pressure, and therefore your heart is under less stress.
C)
Walking helps your heart adjust to your new arteries and provides a way to have
fun.
D)
When you walk, the muscles in your legs contract and pump the blood in your
veins back towards your heart, which allows more blood to return to your heart.
Ans: D
Feedback:
Veins, unlike arteries, are equipped with valves that allow blood to move against the
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force of gravity. The legs have one-way bicuspid valves that prevent blood from seeping
backward as it moves forward by the muscles in our legs pressing on the veins as we
walk and increasing venous return. Option A is incorrect; the arteries in your legs do
constrict when you walk, which allows the blood to move faster and with more pressure
on the tissue, but the greater concern is increasing the flow of venous blood to the heart.
Option B is incorrect; walking increases, not decreases, the heart' pumping ability, which
increases your heart rate and blood pressure and increases the hearts ability to manage
stress. Option C is incorrect; walking does help the heart adjust to new arteries and
provides a way to have fun, but the patient had a myocardial infarctionthere are no
new arteries.
16.The nurse is caring for a patient who is admitted to your unit with a diagnosis of venous
ulceration unresponsive to treatment. What is the nurse most likely to find during an
assessment of this patient?
A) Gangrene B) Heavy exudate C) Deep wound bed D) Pale wound bed
Ans: B
Feedback:
Ulcerations are in the area of the medial or lateral malleolus (gaiter area) and are
typically large, superficial, and highly exudative. Venous hypertension causes
extravasation of blood, which discolors the area.
17.The nursing instructor is talking about anticoagulant therapy. The instructor explains that
when administering warfarin (Coumadin) to a client with deep vein thrombophlebitis,
the nurse monitors the PTT, PT , INR, and hematocrit. Which laboratory value would the
instructor teach the class that indicate warfarin is at therapeutic levels?
A)
Partial thromboplastin time (PTT) 1 to 2 times the control
B)
Prothrombin time (PT) 1 to 2 times the control
C)
International normalized ratio (INR) of 3 to 4
D)
Hematocrit of 32%
Ans: B
Feedback:
Warfarin is at therapeutic levels when the client's PT is 1 to 2 times the control. Higher
values indicate increased risk of bleeding and hemorrhage, whereas lower values
indicate increased risk of blood clot formation. Heparin, not warfarin, prolongs PTT. The
INR may also be used to determine if warfarin is at a therapeutic level. An INR of 2 to 3
is considered therapeutic. Hematocrit does not provide information on the effectiveness
of warfarin; however, a falling hematocrit in a client taking warfarin may be a sign of
hemorrhage.
18.In the clinic you are caring for a 57-year-old client who reports experiencing leg pain
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A)
B)
C)
D)
whenever she walks several blocks. The patient has type 1 diabetes and has smoked a
pack of cigarettes every day for the past 40 years. The physician diagnoses intermittent
claudication. You should provide what instruction about long-term care to the client?
Practice meticulous foot care.
Consider cutting down on your smoking.
Reduce your exercise level.
See the physician if the symptoms bother you.
Ans: A
Feedback:
The patient with peripheral vascular disease or diabetes mellitus should receive
education or reinforcement about skin and foot care. Intermittent claudication and other
chronic peripheral vascular diseases reduce oxygenation to the feet, making them
susceptible to injury and poor healing; therefore, meticulous foot care is essential. The
nurse should teach the client to bathe his feet in warm water, dry them thoroughly, cut
his toenails straight across, wear well-fitting shoes, and avoid taking medication unless
cleared by the physician. The client should stop smokingnot just cut downbecause
nicotine is a vasoconstrictor. Daily walking benefits the client with intermittent
claudication. The client should see the physician regularly, not just when she is bothered
by symptoms.
19.A patient who has undergone a femoral to popliteal bypass graft surgery returns to your
unit. Which assessments should be performed during the first postoperative day?
A)
Assess pulse of affected extremity every 15 minutes at first.
B)
Assess pulse of affected extremity every shift.
C)
Ensure the patient is crossing the legs.
D)
Perform Doppler evaluation every 4 hours.
Ans: A
Feedback:
The primary objective in the postoperative period is to maintain adequate circulation
through the arterial repair. Pulses, Doppler assessment, color and temperature, capillary
refill, and sensory and motor function of the affected extremity are checked and
compared with those of the other extremity; these values are recorded initially every 15
minutes and then at progressively longer intervals if the patient's status remains stable.
The patient should be encouraged not to cross the legs, and Doppler evaluations should
be performed every 2 hours.
20.You are caring for a patient who is diagnosed with Raynaud's disease. What is this
disease characterized by?
A)
Venous thrombosis
C) Arterial vasodilatation
B)
Arteriolar vasoconstriction
D) Intermittent claudication
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Ans: B
Feedback:
Raynaud's disease is characterized by intermittent arteriolar vasoconstriction, causing
coldness, pain, and pallor of the fingertips or toes. Raynaud's disease is not characterized
by venous thrombosis, arteriolar vasodilatation, or intermittent claudication.
21.A patient presents to the clinic complaining of the inability to grasp objects with the right
hand. The patient's right arm is cool and has a difference in blood pressure of more than
20 mm Hg. What would the nurse suspect this patient has?
A)
PAD
B)
Raynaud's disease
C)
Upper extremity arterial occlusive disease
D)
Upper extremity venous insufficiency
Ans: C
Feedback:
The patient typically complains of arm fatigue and pain with exercise (forearm
claudication) and inability to hold or grasp objects (eg, combing hair, placing objects on
shelves above the head) and occasionally difficulty driving. Assessment findings include
coolness and pallor of the affected extremity, decreased capillary refill, and a difference
in arm blood pressures of more than 20 mm Hg.
22.A nurse working in a long-term care facility notes that a new patient, 85 years old, has
gangrene of the toes. The nurse knows that gangrene in the elderly is often the first sign
of what?
A) CWD B) ABI C) AAI D) PAD
Ans: D
Feedback:
In elderly people, symptoms of peripheral arterial disease may be more pronounced than
in younger people. In elderly patients who are inactive, gangrene may be the first sign of
disease. CWD means continuous wave doppler. ABI is ankle-brachial index and AAI is
ankle-arm index.
23.The prevention of DVT is an important part of the nursing care of all high-risk patients.
When providing patient teaching for these high-risk patients, the nurse should advise
lifestyle changes. What might these lifestyle changes include? (Mark all that apply.)
A)
Use of a hot tub or whirlpool bath
B)
Weight loss
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C)
D)
E)
Regular exercise
Smoking cessation
Water aerobics
Ans: B, C, D
Feedback:
Patients should be advised to make lifestyle changes as appropriate, which may include
weight loss, smoking cessation, and regular exercise. The use of a hot tub or whirlpool
bath would not generally be advised by the nurse. Water aerobics is a form of exercise,
so it is incorrect.
24.You are caring for a patient who is on thrombolytic therapy. The patient has a
comorbidity of renal insufficiency. What do you know about the amount of heparin
required to treat this patient?
A)
You cannot use heparin to treat this patient.
B)
You do not need to use an infusion pump for this patient.
C)
Lower doses are required.
D)
Higher doses are required.
Ans: C
Integrated Process: Caring
Feedback:
If renal insufficiency exists, lower doses of heparin are required. An infusion pump is
used for all patients receiving an IV infusion of heparin.
25.The community health nurse is presenting an educational event for a local corporation.
The subject is varicose veins, their treatment and prevention. What should the nurse tell
the employees of the corporation, ages 18 to 65, about the prevention of varicose veins?
A)
Walk at least mile every day.
B)
Gymnastics is a good exercise.
C)
Take the escalator instead of the stairs.
D)
Take the stairs instead of the elevator.
Ans: D
Difficulty: Easy
Feedback:
The patient is encouraged to walk 1 or 2 miles each day if there are no contraindications.
Walking up the stairs rather than using the elevator or escalator is helpful, and swimming
is good exercise. Gymnastics would not be recommended as a good exercise for the
employees of this corporation because of their age.
26.Graduated compression stockings are used to treat and prevent venous insufficiency, leg
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ulcers, and varicose veins. What amount of compression would be prescribed for patients
with venous stasis ulceration?
A) 2030 mm Hg B) 2535 mm Hg C) 3545 mm Hg D) 4050 mm Hg
Ans: D
Cognitive Level: Comprehension
Difficulty: Easy
Feedback:
Graduated compression stockings usually are prescribed for patients with venous
insufficiency. The amount of pressure gradient is determined by the amount and severity
of venous disease. For example, a 20- to 30-mm Hg pressure gradient is prescribed for
patients with asymptomatic varicose veins, whereas at least a 40-mm Hg pressure
gradient is prescribed for patients with venous stasis ulceration. This makes options A, B,
and C incorrect
27.The nurse caring for a patient with leg ulcers has finished assessing the patient and is
developing a problem list prior to writing a plan of care. What major nursing diagnosis,
based on the assessment findings, might the problem list include?
A)
Imbalanced nutrition: more than body requirements
B)
Inactivity related to age and disease process
C)
ROM related to age and disease process
D)
Imbalanced nutrition: less than body requirements
Ans: D
Integrated Process: Communication and Documentation
Feedback:
Based on the assessment data, major nursing diagnoses for the patient may include
Impaired skin integrity related to vascular insufficiency; Impaired physical mobility
related to activity restrictions of the therapeutic regimen and pain; and Imbalanced
nutrition: less than body requirements, related to increased need for nutrients that
promote wound healing. The scenario does not mention the patient's age, so a nursing
diagnosis cannot be formulated based on age. ROM is not a nursing diagnosis.
28.When caring for a patient with leg ulcers, the positioning of the legs depends on whether
the ulcer is arterial or venous in origin. How would you position a patient who has leg
ulcers that are venous in origin?
A)
Keep the legs flat without the knee gauche raised.
B)
Gauche the knees to about a 45 angle.
C)
Elevate lower extremities.
D)
Hang the legs over the side of the bed.
Ans: C
Feedback:
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Positioning of the legs depends on whether the ulcer is of arterial or venous origin. If
there is arterial insufficiency, the patient should be referred for evaluation for vascular
reconstruction. If there is venous insufficiency, dependent edema can be avoided by
elevating the lower extremities. A decrease in edema promotes the exchange of cellular
nutrients and waste products in the area of the ulcer, promoting healing.
29.You are evaluating the outcomes of a patient with leg ulcers. What would be a positive
outcome for one of these patients?
A)
Plans a diet that is nutritionally sound.C) Exhibits positive wound culture.
B)
Reports that pain impedes activity.
D) Maintains minimal level of activity.
Ans: A
Feedback:
Expected patient outcomes may include: 1. Demonstrates restored skin integrity, a.
Exhibits absence of inflammation, b. Exhibits absence of drainage; negative wound
culture, c. Avoids trauma to the legs; 2. Increases physical mobility, a. Progresses
gradually to optimal level of activity, b. Reports that pain does not impede activity; 3.
Attains adequate nutrition, a. Selects foods high in protein, vitamins, iron, and zinc, b.
Discusses with family members dietary modifications that need to be made at home, c.
Plans, with the family, a diet that is nutritionally sound.
30.You are caring for a patient with leg ulcers. You have taken a careful nursing history.
What should this nursing history include? (Mark all that apply.)
A)
Location of pain
B)
History of CAD is documented as a comorbidity
C)
Quality of peripheral pulses are assessed
D)
Temperature of skin of both legs is compared
E)
Limitation of mobility is identified
Ans: C, D, E
Feedback:
A careful nursing history and assessment are important. The extent and type of pain are
carefully assessed, as are the appearance and temperature of the skin of both legs. The
quality of all peripheral pulses is assessed, and the pulses in both legs are compared. The
legs are checked for edema. If the extremity is edematous, the degree of edema is
determined. Any limitation of mobility and activity that results from vascular
insufficiency is identified. The patient's nutritional status is assessed, and a history of
diabetes, collagen disease, or varicose veins is obtained. The nurse would have no need
to assess the location of the pain if the patient has leg ulcers. A history of CAD is not
pertinent as a comorbidity.
31.A patient with lymphangitis presents to the walk-in clinic. The nurse knows that the
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A)
B)
A)
B)
usual infectious organism in lymphangitis is what?

Staphylococcus aureus
C) Haemophilus influenzae
Pseudomonas aeruginosa
D) Hemolytic Streptococcus
Ans: D
Feedback:
Lymphangitis is an acute inflammation of the lymphatic channels. It arises most
commonly from a focus of infection in an extremity. Usually, the infectious organism is a
hemolytic Streptococcus. Therefore options A, B, and C are incorrect.
32.What is secondary lymphedema caused by?
Acquired obstructions
C) Chronic arterial insufficiency
Congenital malformation
D) Chronic venous insufficiency
Ans: A
Cognitive Level: Knowledge
Difficulty: Easy
Feedback:
Lymphedema may be primary (congenital malformations) or secondary (acquired
obstructions). Secondary lymphedema is not caused by either chronic arterial or venous
insufficiency.
33.A nurse is taking care of a patient with secondary lymphedema of the right leg. The
patient has a history of chronic thrombophlebitis. What does the nurse know is the usual
cause of the lymphatic obstruction in a patient with this history?
A)
Elephantitis
C) Chronic lymphangitis
B)
Chronic arterial insufficiency
D) Chronic venous insufficiency
Ans: C
Feedback:
The obstruction may be in the lymph nodes and the lymphatic vessels. Sometimes, it is
seen in the arm after an axillary node dissection (eg, for breast cancer) and in the leg in
association with varicose veins or chronic thrombophlebitis. In the latter case, the
lymphatic obstruction usually is caused by chronic lymphangitis. Therefore options A, B,
and D are incorrect.
34.What is the systemic arteriovenous oxygen difference?
A)
The average amount of oxygen removed by each organ in the body
B)
The amount of oxygen removed from the blood by the heart
C)
The amount of oxygen returning to the lungs via the pulmonary artery
D)
The amount of oxygen in aortic blood minus the amount of oxygen in the vena
caval blood
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Ans: D
Feedback:
The average amount of oxygen removed collectively by all of the body tissues is about
25%. This means that the blood in the vena cava contains about 25% less oxygen than
aortic blood. This is known as the systemic arteriovenous oxygen difference
35.The physiology instructor is talking about adequate blood flow with the pre-nursing
students. What would the instructor tell the students that adequacy of blood flow depends
on? (Mark all that apply.)
A)
Efficiency of heart as a pump
B)
Adequacy of circulating blood volume
C)
Resistance of blood vessel walls
D)
Amount of atherosclerosis in vessels
E)
Patency and responsiveness of the blood vessels
Ans: A, B, E
Feedback:
Adequate blood flow depends on the efficiency of the heart as a pump, the patency and
responsiveness of the blood vessels, and the adequacy of circulating blood volume.
Adequacy of blood flow does not depend on the resistance of the vessel walls or the
amount of atherosclerosis in the vessels.
36.A nurse is assessing a new patient who is diagnosed with peripheral arterial disease. The
nurse cannot feel the pulse in the patient's left foot. What could the nurse use to assess
the blood flow in the patient's left foot?
A)
An ultrasound machine
C) A fetascope
B)
A stethescope
D) CW Doppler
Ans: D
Difficulty: Easy
Feedback:
When pulses cannot be reliably palpated, a hand-held continuous wave (CW) Doppler
ultrasound device may be used to hear (insonate) the blood flow in vessels. This handheld device emits a continuous signal through the patient's tissues. The signals are
reflected by (echo off) the moving blood cells and are received by the device. The
filtered-output Doppler signal is then transmitted to a loudspeaker or headphones, where
it can be heard for interpretation. A regular ultrasound machine cannot assess blood flow
in the patient's foot; neither can a stethoscope or a fetascope (which is used to assess the
heartbeat of a fetus).
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Circulation
37.The steps to obtaining an ABI are:

1. Apply the appropriate size blood pressure cuff to the patient's ankle above the
malleolus.
2. Measure brachial pressures in both arms.
3. Have the patient rest in a supine position for about 5 minutes.
4. Palpate the posterior tibial and dorsalis pedis arteries.
Put the steps of measuring an ABI in the correct order.
A) 1, 2, 3, 4 B) 4, 2, 1, 3 C) 3, 1, 4, 2 D) 2, 4, 3, 1
Ans: C
Feedback:
The first step in determining the ABI is to have the patient rest in a supine position (not
seated) for approximately 5 minutes. An appropriate-sized blood pressure cuff (typically,
a 10-cm cuff) is applied to the patient's ankle above the malleolus. After identifying an
arterial signal at the posterior tibial and dorsalis pedis arteries, the systolic pressures are
obtained in both ankles. Diastolic pressures in the ankles cannot be measured with a
Doppler. If pressure in these arteries cannot be measured, pressure can be measured in
the peroneal artery, which can also be assessed at the ankle. Doppler ultrasonography is
used to measure brachial pressures in both arms.
38.The nurse is caring for a client with a leg ulcer caused by arterial insufficiency. The
nurse knows that a recommended treatment for arterial insufficiency of the leg is what?
A)
Embolectomy
C) TED hose
B)
Compression stockings
D) Vascular reconstruction
Ans: D
Feedback:
If there is arterial insufficiency, the patient should be referred for evaluation for vascular
reconstruction. An embolectomy is the removal of a clot. Compression stockings are
used in venous insufficiency. TED hose are anti-embolism stockings.
39.A 79-year-old male is admitted to your floor with digital gangrene. The man states that
he stubbed his toe going to the bathroom in the dark and that is what started the
gangrene. You know that a cause of digital gangrene is what?
A) Venous insufficiency B) CAD C) Arterial insufficiency D) Varicose veins
Ans: C
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Teaching/learning
Feedback:
Arterial insufficiency may result in gangrene of the toe (digital gangrene), which usually
is caused by trauma. The toe is stubbed and then turns black. Options A, B, and D are
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Circulation
incorrect as they are not the usual causes of digital gangrene in the elderly.
40.When assessing venous disease in the lower extremities, the nurse knows that what test
will most likely be ordered?
A) Duplex Ultrasonography B) CW Doppler C) CT D) MRA
Ans: A
Feedback:
The procedure primarily helps determine the level and extent of venous disease. CW
Doppler testing is used to diagnose peripheral arterial occlusive disease. A CT provides
cross-sectional images of soft tissue and visualizes the area of volume changes to an
extremity and the compartment where changes take place. Magnetic resonance
angiography (MRA) is performed with a standard magnetic resonance imaging (MRI)
scanner and special software programmed to isolate the blood vessels. The resulting
images resemble a standard angiogram, but the images can be rotated and viewed from
multiple angles.
Page 16

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Chapter 31: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral

patient at an increased risk of developing what?

Cognitive Level: Application

Option D is incorrect; Raynaud's disease is a disorder that involves spasms of blood

usual infectious organism in lymphangitis is what?

37.The steps to obtaining an ABI are:

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