Abdominal Aortic Aneurysms
Vasculitis
Cholesterol
Blood Pressure
Aneurysms
100
A patient is diagnosed with an abdominal aortic aneurysm (AAA). Which of the patients vital signs will be a priority for the healthcare provider to monitor? A) Pulse Rate B) Respiratory Rate C) Blood Pressure D) Core Temperature
C) Blood pressure. Blood pressure should be monitored most closely in this patient. Avoiding hypertension is important because this could promote enlargement and rupture of the aneurysm. Hypotension could signal that rupture has occurred and blood volume has been lost. Respiratory rate and pulse rate may be elevated in early shock secondary to AAA leakage or rupture.
100
QUESTION 1. The healthcare provider is explaining to a patient the reason why vasculitis causes damage to the blood vessels in the body. Which of the following is the best explanation? A) 
“Atherosclerotic plaque is causing narrowing of your blood vessels.” B) “High blood pressure is damaging the delicate lining of your arteries.” C) "Your immune system is overreacting and causing damage to the vessel walls.” D) “Your platelets are extra sticky so they form lots of clots in the blood
C) "Your immune system is overreacting and causing damage to the vessel walls.”
100
The client presents to the clinic with a serum cholesterol of 275 mg/dl and is placed on rosuvastatin (Crestor). Which instruction should be given to the client? A) Report muscle weakness to the physician. B) Allow 6 months for the drug to take effect. C) Take the medication with fruit juice. D) Ask the doctor to perform a complete blood count prior to starting the medication.
A) Report muscle weakness to the physician. The client taking antilipidemics should be encouraged to report muscle weakness because this is a sign of rhabdomyositis. The medication takes effect within 1 month of beginning therapy, so answer B is incorrect. The medication should be taken with water. Fruit juice, particularly grapefruit juice, can decrease the drug's effectiveness, so answer C is incorrect. Liver function studies, not a CBC, should be checked prior to beginning the medication, so answer D is incorrect.
100
When discussing hypertension with a student, which of the following will the healthcare provider identify as a factor related to hypertension? A) Hypovolemia B) Decreased cardiac output C) Hypovolemia D) Increased afterload
D) Increased afterload. Blood pressure increases as vascular volume increases (preload). Blood pressure increases as cardiac output (heart rate X stroke volume) increases. Vasoconstriction causes increased afterload and increased blood pressure.
100
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
C) 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.
200
The healthcare provider is assessing a patient who has been diagnosed with an abdominal aortic aneurysm (AAA). Which assessment finding is an indication that the aneurysm is expanding? A) Hoarseness and cough B) Dysphasia C) A report of lower back pain D) Anginal Pain
C) A report of lower back pain. Symptoms of an AAA are the result of compression of abdominal structures, so back and abdominal pain are often reported. Anginal pain may be a symptom of compromised cardiac perfusion secondary to a thoracic aortic aneurysm.
200
A 44-year-old male with a history of heavy smoking comes to the clinic complaining of paresthesias and pain of the hands and fingers. The patient states: “My hands hurt even when I’m not using them.” Radial pulses are +1 and the fingers are cool to the touch. A diagnosis of Buerger’s disease (thromboangiitis obliterans) is made. The plan of care for this patient will include: A) Abstinence from alcohol 
B) Smoking cessation 
C) Low dose aspirin D) Warm compresses
B) Smoking cessation. Buerger’s disease has a strong link to cigarette smoking and other forms of tobacco. Even though there is thrombus formation, antiplatelet medications have no effect on Buerger’s disease. Quitting smoking is the only treatment for this disease. Scratchpad
200
A patient who had a mitral valve replacement with a prosthetic mechanical valve and is ready for discharge home. Which information should the healthcare provider include in the discharge teaching for this patient? Select all that apply. A) “Your valve will need to be replaced after 10 years.” B) “If you plan to become pregnant, be sure to consult your healthcare provider.” C) “You may need to take an antibiotic before certain medical or dental procedures.” D) “You will need to come in regularly for coagulation studies." E) “Call our office immediately if you experience an infection of any kind.”
B) “If you plan to become pregnant, be sure to consult your healthcare provider.” C) “You may need to take an antibiotic before certain medical or dental procedures.” D) “You will need to come in regularly for coagulation studies.” E) “Call our office immediately if you experience an infection of any kind."
200
A woman in her second trimester of pregnancy is diagnosed with preeclampsia. Which of the following statements about preeclampsia will guide the care provided to this patient? A) The most serious problem with preeclampsia is edema, which is treated with diuretics. B) If untreated, preeclampsia may result in fetal growth restriction. C) Preeclampsia is the most common cause of delivery after 40 weeks gestation. D) The patient should not be concerned because the disorder will not affect the fetus.
B) If untreated, preeclampsia may result in fetal growth restriction. * Impaired perfusion results in decreased delivery of oxygen and nutrients to the fetus, restricting fetal growth.
200
The nurse must be alert to complications in the patient who has suffered a ruptured intracranial aneurysm. The nurse should assess the patient for signs of which of the following?
 Select all that apply.
 A) headache 
B) hydrocephalus
 C) rebleeding 
D) vasospasm 
E) stiff neck
B) hydrocephalus. C) rebleeding. D) vasospasm. Headache is a sign of a probable rebleed. Hydrocephalus, rebleeding, and vasospasm are the three major complications that a nurse must anticipate following a ruptured intracranial aneurysm. Stiff neck is a manifestation of intracranial aneurysm, not a complication.
300
An unconscious patient arrives at the emergency department. Periumbilical (Cullen's sign) and flank ecchymosis (Grey Turner's sign) is noted, and a ruptured abdominal aortic aneurysm (AAA) is suspected. Which of theses additional assessment findings will the healthcare provider anticipate? A) Decorative posturing B) Expiratory wheezes C) Pale, clammy skin D) Pinpoint pupils
C) Pale, clammy skin. In hypovolemic shock, a patient may present with pale, clammy skin as circulating volume decreases and peripheral vessels constrict in an attempt to shunt available blood to vital organs.
300
The patient is receiving high dose corticosteroids for the treatment of Wegener granulomatosis. The healthcare provider correctly recognizes which of the following symptoms as an adverse effect of treatment with this drug? Select all that apply. 
A) Hyperglycemia 
B) Abdominal striae C) 
“Moon face” D) Exophthalmos E) Myxedema
A) Hyperglycemia. B)Abdominal striae and C) “Moon face”. Corticosteroids tend to increase glucose levels. If a patient is diabetic or has any compromise in pancreatic function, hyperglycemia is a risk.
300
A patient with a history of coronary artery disease is being treated for a myocardial infarction (MI). During treatment, acute mitral valve regurgitation occurs. What is the most likely cause of the acute mitral valve dysfunction? A) Atherosclerosis B) Ventricular fibrillation C) Rupture of the chordae tendinae D) Infective endocarditis
C) Rupture of the chordae tendinae
300
A patient presents to the emergency department with a blood pressure of 180/130 mmHg, headache, and confusion. Which additional finding is consistent with a diagnosis of hypertensive emergency? A) Bradycardia B) Retinopathy C) Urinary retention D) Jaundice
B) Retinopathy. A hypertensive emergency may cause hypertensive retinopathy, resulting in hemorrhages, exudates, and/or papilledema.
300
Prodromal manifestations prior to an intracranial aneurysm rupture could be recognized by the nurse as which of the following? 
Select all that apply.
 A) visual deficits 
B) headache 
C) mild nausea 
D) dilated pupil
 E) stiff neck
A) visual deficits. B) headache. D) dilated pupil. Often intracranial aneurysms are asymptomatic until rupture but patients can complain of headache and eye pain, and have visual deficits and a dilated pupil. Nausea and vomiting and stiff neck are not usually associated with the prodromal manifestations of an intracranial aneurysm, but may occur with leaking or rupture.
400
During an assessment of a patient's abdomen, a pulsating abdominal mass is noted by the healthcare provider. Which of the following should be the healthcare provider's next action? A) Assess femoral pulses B) Obtain a bladder scan C) Measure the abdominal circumference D) Ask the patient to perform a Valsalva maneuver
A) Assess femoral pulses. A pulsating mass may indicate the presence of an abdominal aneurysm. Assessing the pulses distal to the aneurysm will provide information regarding the degree of circulatory compromise. Increasing abdominal girth may be associated with a ruptured aneurysm. Asking the patient to bear down (Valsalva maneuver) is appropriate if a hernia is suspected.
400
The physical examination of a 58-year-old woman reveals the following: elevated erythrocyte sedimentation rate, temporal artery tenderness, and blurry vision. A biopsy of the temporal artery confirms a diagnosis of temporal arteritis. While caring for this patient, the healthcare provider will anticipate an order to administer: A) Corticosteroids 
B) Anticoagulants 
C) Antibiotics 
D) Ferrous sulfate
A) Corticosteriods. Corticosteroids are powerful anti-inflammatory drugs used to treat temporal arteritis because they suppress the actions of inflammatory cells and inflammatory chemical mediators.
400
Because a client has mitral stenosis and is a prospective valve recipient, the nurse preoperatively assesses the client’s past compliance with medical regimens. Lack of compliance with which of the following regimens would pose the greatest health hazard to this client? A) Medication therapy B) Diet modification C) Activity restrictions D) Dental care
A) Medication therapy. Preoperatively, anticoagulants may be prescribed for the client with advanced valvular heart disease to prevent emboli. Post-op, all clients with mechanical valves and some with bioprostheses are maintained indefinitely on anticoagulation therapy. Adhering strictly to a dosage schedule and observing specific precautions are necessary to prevent hemorrhage or thromboembolism. Some clients are maintained on lifelong antibiotic prophylaxis to prevent recurrence from rheumatic fever. Episodic prophylaxis is required to prevent infective endocarditis after dental procedures or upper respiratory, GI, or GU surgery.
400
The results of an adult patient’s blood pressure screening on three occasions are: 120/80 mmHg, 130/76 mmHg, and 118/86 mmHg. How will the healthcare provider interpret this information? A) Hypertension Stage 2 B) Prehypertension C) Hypertension Stage 1 D) Normal blood pressure
B) Prehypertension. This patient has prehypertension, which is defined as 120 - 139 mmHg systolic or 80 - 89 mmHg diastolic.
400
Which of the following treatments is the definitive one for a ruptured aneurysm? A) Antihypertensive medication administration B) Aortogram C) Beta-adrenergic blocker administration D) Surgical intervention
D) 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.
500
Aortic aneurysms take varied forms and can occur anywhere along the aorta. What are the types of aneurysm termed abdominal aortic aneurysms? (Select all that apply) A) Berry aneurysms B) Dissecting aneurysms C) Saccular aneurysms D) Fusiform aneurysms E) Bifurcating aneurysms
C) Saccular aneurysms and D) Fusiform aneurysms. Abdominal aortic aneurysms can involve any part of the vessel circumference (saccular) or extend to involve the entire circumference (fusiform). Berry aneurysms typically occur in the circle of Willis. Dissecting aneurysms are false aneurysms and typically occur in the thoracic aorta. Aneurysms can occur at the bifurcation of a blood vessel but are not termed bifurcating aneurysms.
500
A 9-month-old child is transferred to the pediatric unit from the ED. The patient is febrile and fussy. He has conjunctivitis, bright red lips and tongue, a body rash with peeling skin on the hands and feet. The parents say this started with a fever about a week ago, and has progressed. For which priority diagnostic test will the healthcare provider prepare? A) 
Echocardiogram 
B) Blood culture 
C) Electrocardiogram 
D) Chest X-ray
A) Echocardiogram. An echocardiogram can identify damage to the vessels of the heart, including thrombosis, valve muscle damage, and pericardial effusion caused by ruptured vessels in the heart.
500
Which of the following signs and symptoms would most likely be found in a client with mitral regurgitation? A) Exertional dyspnea B) Confusion C) Elevated creatine phosphokinase concentration D) Chest pain
A) Extertional dyspnea. Weight gain, due to fluid retention and worsening heart failure, causes exertional dyspnea in clients with mitral regurgitation. The rise in left atrial pressure that accompanies mitral valve disease is transmitted backward into pulmonary veins, capillaries, and arterioles and eventually to the right ventricle. Signs and symptoms of pulmonary and systemic venous congestion follow.
500
A patient is prescribed a new medication for the treatment of hypertension. While supine, the patient’s blood pressure is 112/70 mmHg and the heart rate is 80/minute. The healthcare provider assesses the patient when the patient changes to a sitting position. Which of the following indicates the patient is experiencing orthostatic hypotension? A) BP 90/60, HR 68 B) BP 120/84, HR 82 C) BP 88/62, HR 100 D) BP 100/66, HR 90
D) BP 100/66, HR 90. Orthostatic hypotension is defined as a decrease of more than 20 mmHg systolic or more than 10 mmHg diastolic and a 10% - 20% increase in heart rate.
500
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
C) Media. The factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less elastic fibers, so it’s more capable of vasoconstriction and vasodilation. The interna and externa are generally no damaged in an aneurysm.
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