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PVD practice questions with correct
answers
A nurse is assessing a client who has chronic venous insufficiency. Which of the following findings should the nurse expect? a. dependent rubor b. edema c. hair loss d. thick, deformed toenails - CORRECT ANSWERS ✔✔b PVD- veins pump blood back to the heart but when it gets occluded the blood pools PAD-arteries carries blood from the heart to the extremities so if it can't get there, the extremities don't get blood A nurse is reviewing discharge instructions with a client who has Raynaud's disease. Which of the following client statements indicates an understanding of the teaching? "I plan to use nicotine gum to help me quit smoking." "I am going to take a stress management class." "I will limit myself to only two cups of coffee in the morning."
"I should not drive in the winter months." - CORRECT ANSWERS ✔✔"I am going to take a stress management class." The nurse should instruct the client that stress can elicit attacks. The client should learn to avoid stressful situations when possible and learn to manage stress to limit the occurrence of attacks. When checking a client's capillary refill, the nurse finds that the color returns in 10 seconds. The nurse should understand that this finding indicate ____________ insufficiency. - CORRECT ANSWERS ✔✔Arterial If the skin color takes longer than 3 seconds to return to normal, this indicates impaired arterial blood flow to the extremity.Arteries push blood from heart to extremities. A nurse is providing discharge teaching to a client who has peripheral arterial disease (PAD). Which of the following instructions should the nurse include in the teaching? A. Apply a heating pad on a low setting to help relieve leg pain B. Adjust the thermostat so that the environment is warm C. Wear antiembolic stockings during the day D. Rest with the legs above heart level - CORRECT ANSWERS ✔✔B
irregularly shaped sores N- no sharp pain during exercise, dull pain Y- yellow and brown ankles) A nurse is caring for a client who has peripheral arterial disease (PAD). Which of the following symptoms should the nurse expect to find in the early stage of the disease? A. Intermittent claudication B. Dependent Rubor C. Rest Pain D. Foot ulcers - CORRECT ANSWERS ✔✔B Vascular disorders - CORRECT ANSWERS ✔✔Peripheral vascular disease: progressive circulation disorder Peripheral artery disease: Thickening of artery walls
- Leading cause: Atherosclerosis When arteries don't work properly, your feet and legs can't get enough oxygen and other needed supplies, like nutrients. And when veins aren't working, there can be a buildup of blood materials, like fluid, in your limbs. The two diseases differ in several key ways. PAD means you have narrowed or blocked arteries -- the vessels that carry oxygen-rich blood as it moves away from your heart to other parts of your body.
PVD, on the other hand, refers to problems with veins -- the vessels that bring your blood back to your heart. PAD-can occur more with atherosclerosis and PVD can have valves in your veins back flow in the wrong direction so this is why is causes the leg edema Risk factors: Tobacco use Diabetes Hyperlipidemia Elevated C-reactive protein Uncontrolled hypertension Stress Sedentary lifestyle Obesity Non-modifiable risk factors: age, gender, familial predisposition/genetics Common Sites of Atherosclerotic Obstruction - CORRECT ANSWERS ✔✔ Peripheral Arterial Insufficiency—Assessment - CORRECT ANSWERS ✔✔Subjective:
ABI (ankle brachial index) - CORRECT ANSWERS ✔✔test that measures arterial perfusion using a Doppler unit. blood pressures are measured in both UEs and LEs and highest LE systolic pressure is divided by brachial systolic pressure. ABI (Ankle Brachial Index) Ankle systolic pressure divided by brachial systolic pressure normal = 1.0 - 1. below 1.0 suggests arterial obstruction 0.8 - 1.0 mild 0.5 - 0.7 moderate < 0.5 severe Exercise tolerance testing - CORRECT ANSWERS ✔✔For patients with chronic pulmonary disease to see if you have CAD CT Coronary Angiography - CORRECT ANSWERS ✔✔views cardiac motion throughout the entire cardiac cycle receive beta blockers to slow the HR to be able to take the pictures
Nitroglycerin given immediately before the scan to achieve vasodilation Computed Tomography (CT) with/without dye - CORRECT ANSWERS ✔✔Magnetic Resonance Angiogram (MRA) Arteriogram - CORRECT ANSWERS ✔✔radiographic image of an artery (after an injection of contrast media) Nursing Process: Peripheral Arterial Insufficiency What are these patients at risk for? What are your goals for a patient with peripheral arterial insufficiency?
- CORRECT ANSWERS ✔✔Impaired skin integrity, risk for infection, pain, altered tissue perfusion Skin care (dry and intact), maintain tissue profusion, control pain Nursing Process: PAD: Nursing Interventions to achieve patient goals: (non-surgical) - CORRECT ANSWERS ✔✔1) Exercise
- Foot care
- Positioning (don't cross legs)
- Promote vasodilation (decrease caffeine and nicotine to it doesn't vasoconstriction)
Make an incision in the leg and usually use the saphenous vein to bypass plaque What is the priority risk on post-op day 1 from an Arterial Bypass Graft
- CORRECT ANSWERS ✔✔Nursing interventions Routine post-op care Pain (first sign of reocclusion!!!)!!!!!! most likely to occur within the first 24 hours at the site of graft Assess for graft occlusion - check CSM q 15 min to extremity for first hour, then hourly, then q 4 hrs (circulation, sensation and motion) Mark the area where pulse heard best No bending of extremity until ordered Encourage ambulation (once the doctor says so) Assess for hypotension/hypertension Assess for compartment syndrome/edema Assess for graft infection While working in the outpatient clinic, the nurse notes that a patient has a history of intermittent claudication. Which statement by the patient would support this information? A. "When I stand too long, my feet start to swell." B. "I get short of breath when I climb a lot of stairs." C. "My fingers hurt when I go outside in cold weather."
D. "My legs cramp whenever I walk more than a block." - CORRECT ANSWERS ✔✔D- pain should go away when you stop walking and rest for a little Amputation - CORRECT ANSWERS ✔✔Surgical amputation Indications Sites Traumatic Amputation Might get amputation bc of necrosis, gangrene or osteomyelitis Gangrene - CORRECT ANSWERS ✔✔death of tissue associated with loss of blood supply (necrosis) it turns black Necrosis - CORRECT ANSWERS ✔✔tissue death Osteomyelitis - CORRECT ANSWERS ✔✔infection of the bone Amputation complications - CORRECT ANSWERS ✔✔Hemorrhage Infection Phantom Limb Pain (can put in nerve blocks for this to stop feeling the pain) Risks associated with immobility
Nursing interventions for amputations - CORRECT ANSWERS ✔✔Relief of pain Administer analgesic or other medications as prescribed Changing position Alternative methods of pain relief- distraction, TENS unit Note: Pain may be an expression of grief and altered body image Promoting wound healing Handle limb gently Residual limb shaping Nursing Interventions: Achieving Physical Mobility - CORRECT ANSWERS ✔✔Proper positioning of limb; avoid abduction, external rotation and flexion Turn frequently; prone positioning if possible Use of assistive devices ROM exercises Muscle strengthening exercises "Pre-prosthetic care"; proper bandaging, massage, and "toughening" of the residual limb Rehabilitation needs - CORRECT ANSWERS ✔✔Psychological support Prostheses fitting and use
Physical therapy Occupational training and counseling Use a multidisciplinary team approach; The health care team needs to communicate a positive attitude to facilitate acceptance and participation in rehabilitation. Patient teaching Resolving Grief and Enhancing Body Image - CORRECT ANSWERS ✔✔- accept and acknowledge your feelings -focus on the journey -find a purpose -learn to think of yourself in a new way -talk to other amputees Buerger's Disease—Thromboangiitis Obliterans - CORRECT ANSWERS ✔✔Recurring inflammatory process of the small and intermediate vessels of (usually) the lower extremities Inflammatory thrombus forms and blocks vessels Most often occurs in men ages 20 to 35. Risk or aggravating factor: Progressive occlusion of vessels results in pain, ischemic changes, ulcerations, and gangrene. Treatment: smoking cessation, antibiotics, avoiding cold limb exposure, amputation
After teaching a patient with newly diagnosed Raynaud's 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 anti-inflammatory drugs (NSAIDs). - CORRECT ANSWERS ✔✔A Aneurysm - CORRECT ANSWERS ✔✔An aneurysm is a sac (outpouching) of an artery formed by weakness or stretching of arterial wall Occur most commonly on aorta ¾ of aortic aneurysms occur in abdomen (AAA) Three types: Fusiform - total cirumference dilated Saccular - one side dilated Dissecting - artery wall is completely separated (happens very quick cause all the blood leaves) Abdominal Aortic Aneurysm (AAA) - CORRECT ANSWERS ✔✔Risk factors Atherosclerosis, HTN, smoking, familial risk, trauma, > men
Signs/symptoms Most often __asymptomatic_______________ Constant abdominal or low back pain SOB or difficulty swallowing Epigastric discomfort Diminished femoral pulses On exam pulsating abdominal mass with bruits Complication: rupture/dissection AAA rupture - CORRECT ANSWERS ✔✔Signs/Symptoms Symptoms vary from "small leak" to "complete rupture", also depends on size of aneurysm Severe abdominal or back pain Grey Turner's Sign Abdominal distension (measure girth) Hypotension, tachycardia/shock Loss of consciousness Urgent Management Poor prognosis Immediate transfer to OR -very serious you need to go to OR or you die
Intraabdominal hypertension Hemorrhage Graft occlusion or rupture Hypovolemia Renal failure Nursing Interventions Post Surgical Repair of AAA - CORRECT ANSWERS ✔✔Monitor peripheral pulses Monitor for graft occlusion (cyanotic/mottled extremities, pain or abd distension) Monitor kidney function Review activity restrictions at discharge No pulling/pushing/lifting heavy (20 lb) objects 6-12 weeks Monitor for signs of hemorrhage After receiving report, which patient admitted to the emergency department should the nurse assess first? A. 67-year-old who has a gangrenous left foot ulcer with a weak pedal pulse B. 58-year-old who is taking anticoagulants for atrial fibrillation and has black stools C. 50-year-old who is complaining of sudden "sharp" and "worst ever" upper back pain
D. 39-year-old who has right calf tenderness, redness, and swelling after a long plane ride - CORRECT ANSWERS ✔✔C Venous disorders - CORRECT ANSWERS ✔✔Thrombosis Venous Insufficiency Varicose Veins Veins - CORRECT ANSWERS ✔✔Vein functioning depends on:
- Valves prevent backflow of blood (Unidirectional)
- Also require muscle to help pump (squeeze) blood back to heart Two things alter venous blood flow:
- Thrombus formation"DVT" "Thrombophlebitis"
- Defective valves Venous Thromboembolism (VTE) - CORRECT ANSWERS ✔✔Risk factors Venous stasis A-fib Obesity Prolonged immobility (bed rest, long trips) Advanced age
