PVD

Arterial Hypertension

100

The 66-year-old male client has his blood pressure (BP) checked at a health fair. The B/P is 168/98. Which action should the nurse implement first? Recommend that the client have his blood pressure checked in one (1) month. Instruct the client to see his health-care provider as soon as possible. Discuss the importance of eating a low-salt, low-fat, low-cholesterol diet. Explain that this B/P is within the normal range for an elderly person.

This BP is elevated and the client should have his BP checked frequently but not before seeking medical treatment. The diastolic blood pressure should be less than 85 according to the American Heart Association; therefore, this client should see the health-care provider. Teaching is important, but the nurse must first make sure the client sees the healthcare provider for a thorough checkup and antihypertensive medication prescription. Diet alone should not be recommended by the nurse. This is not the normal range for an elderly person’s blood pressure; the diastolic should be less than 85 mmHg. TEST-TAKING HINT: Remember the question asks which action should be implemented first. Therefore, there is more than one answer that is appropriate but the first should be the one that directly affects the client.

200

The nurse is teaching the client recently diagnosed with essential hypertension. Which instruction should the nurse provide when discussing exercise? Walk at least 30 minutes a day on flat surfaces. Perform light weight lifting three (3) times a week. Recommend high-level aerobics daily. Encourage the client to swim laps once a week.

Walking 30 to 45 minutes a day will help in reducing blood pressure, weight, and stress and will increase a feeling of overall well-being. Isometric exercises (such as weight lifting) should be discouraged because performing them can raise the systolic blood pressure. The client should walk, cycle, jog, or swim daily; high-level aerobics may increase the client’s blood pressure. Swimming laps is recommended, but it should be daily, not once a week. TEST-TAKING HINT: Remember to look at the frequency of interventions; it makes a differ ence when selecting the correct answers.

300

The health-care provider prescribes an ACE inhibitor for the client diagnosed with essential hypertension. Which statement is the most appropriate rationale for administering this medication? ACE inhibitors prevent the beta-receptor stimulation in the heart. This medication blocks the alpha receptors in the vascular smooth muscle. ACE inhibitors prevent vasoconstriction and sodium and water retention. ACE inhibitors decrease blood pressure by relaxing vascular smooth muscle.

Beta-adrenergic blocking agents, not ACE inhibitors, prevent the beta-receptor stimulation in the heart, which decreases heart rate and cardiac output. Alpha-adrenergic blockers, not ACE inhibitors, block alpha receptors in the vascular smooth muscle, which decreases vasomotor tone and vasoconstriction. Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angio tensin I to angiotensin II, and this, in turn, prevents vasoconstriction and sodium and water retention. Vasodilators, not ACE inhibitors, reduce blood pressure by relaxing vascular smooth muscle, especially in the arterioles. TEST-TAKING HINT: The test taker needs to understand how the major classifications of medications work to answer this question.

400

Diagnosis of Stage I requires

2 separate readings of 130-139/80-89

500

Definition of "White Coat" hypertension

Increased BP 130-160 only during health care visits

Arterial Occlusive Disease

100

The client comes to the clinic complaining of muscle cramping and pain in both legs when walking for short periods of time. Which medical term would the nurse document in the client’s record? Peripheral vascular disease (PVD). Intermittent claudication. Deep vein thrombosis (DVT). Dependent rubor.

PVD is a broad term that encompasses both venous and arterial peripheral problems of the lower extremities. This is the classic symptom of arterial occlusive disease. This is characterized by calf tenderness, calf edema, and positive Homans’ sign. This term is a sign of arterial occlusive disease, the legs are pale when elevated but are dark red when in the dependent position. TEST-TAKING HINT: The test taker could elimi nate “1” and “3” as possible answers if the words “medical term” were noted. Both “1” and “3” are disease processes not medical terms.

200

Which instruction should be included when a client diagnosed with peripheral arterial disease is being discharged? Encourage the client to use a heating pad on lower extremities. Demonstrate to the client the correct way to apply elastic support hose. Instruct the client to walk daily for at least 30 minutes. Tell the client to check both feet for red areas at least once a week.

External heating devices are avoided to reduce the risk of burns. Elastic support hose reduce the circulation to the skin and are avoided. Walking promotes the development of collateral circulation to ischemic tissue and slows the process of atherosclerosis. The feet must be checked daily not weekly. TEST-TAKING HINT: The test taker must note the adjective “week” in “4,” which could elim inate this distracter as a possible answer.

300

The nurse is teaching the client diagnosed with arterial occlusive disease. Which interventions should the nurse include in the teaching? Select all that apply. Wash legs and feet daily in warm water. Apply moisturizing cream to feet. Buy shoes in the morning hours only. Do not wear any type of knee stocking. Wear clean white cotton socks.

Cold water causes vasoconstriction and hot water may burn the client’s feet; there fore, warm tepid water should be recom mended. Moisturizing prevents drying of the feet. Shoes should be purchased in the afternoon when the feet are the largest. This will further decrease circulation to the legs. Colored socks have dye and dirty socks may cause foot irritation that may lead to breaks in the skin. TEST-TAKING HINT: The test taker must select all appropriate interventions; “3” could be eliminated as a correct answer because of “only,” which is an absolute word. There are very few absolutes in health care.

400

The definition of Raynaud's disease

vascular

500

Incidence of PAD true false

men > women _________

and

arteries above the waist > arteries below the waist

Both false

Atherosclerosis

100

The nurse is teaching a class on coronary artery disease. Which modifiable risk factors should the nurse discuss when teaching about atherosclerosis? Stress. Age. Gender. Family history.

25. A modifiable risk factor is a risk factor that can possibly be altered by modifying or changing behavior, such as developing new ways to deal with stress. The client cannot do anything about getting older so it cannot be modified. Gender is a risk factor that cannot be changed. Having a family history of coronary artery disease predisposes the client to a higher risk, but this cannot be changed by the client. TEST-TAKING HINT: The test taker needs to key in on adjectives when reading the stem of a question. The word “modifiable” should cause the test taker to select “stress” because it is the only answer option referring to something that can be changed or modified.

200

The client asks the nurse, “My doctor just told me that atherosclerosis is why my legs hurt when I walk. What does that mean?” Which response by the nurse would be the best response? “The muscle fibers and endothelial lining of your arteries have become thickened.” “The next time you see your HCP ask what atherosclerosis means.” “The valves in the veins of your legs are incompetent so your legs hurt.” “You have a hardening of your arteries that decreases the oxygen to your legs.”

The nurse should assume the client is a layperson and should not explain disease processes using medical terminology. This is passing the buck; the nurse should have the knowledge to answer this question. Atherosclerosis involves the arteries, not veins. This response explains in plain terms why the client’s legs hurt from atherosclerosis. TEST-TAKING HINT: If the test taker knows medical terminology, “3” could be eliminated because “athero” means “arteries,” not veins. The test taker should be very cautious when choosing an option that asks the health-care provider to answers questions that nurses should be able to answer.

300

The client diagnosed with peripheral vascular disease is overweight, has smoked two (2) packs of cigarettes a day for 20 years, and sits behind a desk all day. What is the strongest factor in the development of atherosclerotic lesions? Being overweight. Sedentary lifestyle. High-fat, high-cholesterol diet. Smoking cigarettes.

Being overweight is not a risk factor for atherosclerotic lesions, but it does indicate that the client does not eat a healthy diet or exercise as needed. Lack of exercise is a risk factor, but it is not the strongest. Although the stem did not explicitly identify diet, the nurse should assume that a client who is obese would not eat a low-fat, low-cholesterol diet. Tobacco use is the strongest factor in the development of atherosclerotic lesions. Nicotine decreases blood flow to the extremities and increases heart rate and blood pressure. It also increases the risk of clot formation by increasing the aggrega tion of platelets. TEST-TAKING HINT: The test taker should look at the answer options closely to determine if any are similar. This will help eliminate two options—“1” and “3”—as possible answers. An unhealthy diet will cause the client to be over weight.

Abdominal Aortic Aneurysm

100

Which assessment data would support the diagnosis of abdominal aortic aneurysm (AAA)? Shortness of breath. Abdominal bruit. Ripping abdominal pain. Decreased urinary output.

Shortness of breath indicates a respiratory problem or possible a thoracic aneurysm, not an AAA. A systolic bruit over the abdomen is a diag nostic indication of an AAA. Ripping or tearing pain indicates a dissecting aneurysm. Urine output is not diagnostic of an AAA. TEST-TAKING HINT: The test taker who has no idea of the answer should note that two of the answer options—“2” and “3”—have the word “abdominal” and choose between them, ruling out “1” and “4,” both of which refer to other systems of the body (respiratory and urinary).

200

Which medical treatment would be prescribed for the client with an AAA less than 3 cm? Ultrasound every six (6) months. Intravenous pyelogram yearly. Assessment of abdominal girth monthly. Repair of abdominal aortic aneurysm.

When the aneurysm is small ( < 5–6 cm) an abdominal sonogram will be done every six (6) months until the aneurysm reaches a size at which surgery to prevent rupture is of more benefit than possible complications of an abdominal aortic aneurysm repair. An intravenous pyelogram evaluates the kidney. The abdomen will not distend as the AAA enlarges. This AAA is too small to perform surgery to remove. TEST-TAKING HINT: The AAA less than 3 cm should make the test taker assume that surgery is not an option; therefore “4” could be ruled out as a correct answer. “Pyelo” means “kidney” so “2” could be ruled out. The term “medical treatment” in the stem of the question should cause the test taker to rule out abdominal girth.

300

. Which client would be most likely to develop an abdominal aortic aneurysm? A 45-year-old female with a history of osteoporosis. An 80-year-old female with congestive heart failure. A 69-year-old male with peripheral vascular disease. A 30-year-old male with a genetic predisposition to AAA.

AAAs affect males four (4) times more often than women. AAAs affect males four (4) times more often than women. The most common cause of AAA is athero sclerosis (which is the cause of peripheral vascular disease); it occurs in men four (4) times more often than women and prima rily in Caucasians. AAAs occur most often in elderly men and there is no genetic predisposition. TEST-TAKING HINT: If the test taker knew that AAA and peripheral vascular disease both occur with atherosclerosis, it might possibly lead to the selection of “3” as the correct answer.

Deep Vein Thrombosis

100

The nurse is discharging a client diagnosed with DVT from the hospital. Which discharge instructions should be provided to the client? Have the PTT levels checked weekly until therapeutic range is achieved. Staying at home is best, but if traveling, airplanes are better than automobiles. Avoid green leafy vegetables and notify the HCP of red or brown urine. Wear knee stockings with an elastic band around the top.

The client will be taking an oral anticoagulant, warfarin (Coumadin). Prothrombin time (PT) and International Normalized ratio (INR) levels, not partial thromboplastin time (PTT), are monitored when this medication is taken. The client should be in therapeutic range before discharge. The HCP will determine how often to monitor the levels, usually in two (2) to three (3) weeks and then at three (3) to six (6) month intervals. The client is not restricted to the home. The client should not take part in any activity that does not allow frequent active and passive leg exercises. In an airplane the client should be instructed to drink plenty of fluids, move the legs up and down, and flex the muscles. If in an automobile, the client should take frequent breaks to walk around. Green leafy vegetables contain vitamin K, which is the antidote for warfarin. These foods will interfere with the action of war farin. Red or brown urine may indicate bleeding. The client should be instructed to wear stockings that do not constrict any area of the leg. TEST-TAKING HINT: The test taker must know laboratory data for specific medications. INR and PT are monitored for oral anticoagulants. Remember: “PT boats go to war” (warfarin). PTT monitors heparin (tt is like an H for heparin).

200

The nurse is caring for clients on a surgical floor. Which client should be assessed first? The client who is four (4) day post-operative abdominal surgery and is complaining of left calf pain when ambulating. The client who is one (1) day post-operative hernia repair who has just been able to void 550 mL of clear amber urine. The client who is five (5) day post-operative open cholecystectomy who has a T tube and is being discharged. The client who is 16 hours post–abdominal hysterectomy and is complaining of abdominal pain and is expelling flatus.

A complication of immobility after surgery is developing a DVT. This client with left calf pain should be assessed for a DVT. This is an expected finding. Clients who require an open cholecystectomy frequently are discharged with a T tube. This client needs to know how to care for the tube before leaving, but this is not a priority over a possible surgical complication. This is expected for this client. TEST-TAKING HINT: In priority setting ques tions, the test taker must decide if the infor mation in the answer option is expected or abnormal for the situation. Based on this, “2,” “3,” and “4” can be eliminated.

300

The male client is diagnosed with Guillain Barré syndrome (GB) and is in the intensive care unit on a ventilator. Which cardiovascular rationale explains implementing passive range of motion (ROM) exercises? Passive ROM will prevent contractures from developing. The client will feel better if he is able to exercise and stretch his muscles. Range of motion exercises will help alleviate the pain associated with GB. They help to prevent DVTs by movement of the blood through the veins.

Passive range of motion exercises are recommended to prevent contracture formation and muscle atrophy, but this is a musculoskeletal complication, not a cardiovascular one. If the client is on a ventilator, then the paralysis associated with GB has moved up the spinal column to include the muscles of respiration. Passive range of motion exercises are done by the staff; the client will not be able to do active ROM. Range of motion exercises will not alleviate the pain of GB. One reason for performing range of motion exercises is to assist the blood vessels in the return of blood to the heart, preventing DVT. TEST-TAKING HINT: The question is asking for a cardiovascular reason for range of motion exercises. Options “1,” “2,” and “3” do not have any cardiovascular component. Only “4” discusses veins and blood.