(Osborn) Chapter 43: Learning Outcomes (Number and Title)

[Osborn] chapter 43
Learning Outcomes [Number and Title ]

Learning Outcome 1
Describe the risk factors and clinical findings in peripheral
arterial disease.
Learning Outcome 2
Develop a nursing care plan for the patient with peripheral
arterial disease.
Learning Outcome 3
Compare and contrast the clinical findings and management of
Raynauds disease and Buergers disease.
Learning Outcome 4
Discuss signs and symptoms of common potential
complications of endovascular repair and surgery of the aorta,
and appropriate nursing interventions for each.
Learning Outcome 5
Identify the risk factors, diagnosis, medical management, and
nursing care for deep venous thrombosis.
Learning Outcome 6
Explain the actions of commonly used anticoagulants and
antiplatelet agents used for patients with peripheral arterial
disease and nursing management of the patient receiving them.
Learning Outcome 7
nursing care for varicose veins.
Learning Outcome 8
nursing care for aortic aneurysm and aortic dissection.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.
1. The 65-year-old male client arrives in the clinic complaining of numbness and tingling
of the lower extremities and pain in the legs upon exercise. The nurse asks which of the
following questions to determine other risk factors this client may have for peripheral
arterial disease?
Select all that apply.
1.
2.
3.
4.
5.
Do you smoke?
Are you diabetic?
Are you married?
Do you exercise?
Where were you born?
Correct Answer:
1. Do you smoke?
2. Are you diabetic?
Rationale: Do you smoke? Smoking is a risk factor for peripheral arterial disease
(PAD). Are you diabetic? Diabetes is a risk factor for peripheral arterial disease
(PAD). Are you married? Marital status is not a risk factor for PAD. Do you
exercise? Exercise may help to delay the symptoms of PAD. Where were you born?
Birthplace is not a risk factor for PAD.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 1
2. The client who has just been diagnosed with peripheral arterial disease (PAD) asks
what intermittent claudication means. The nurses best response is that intermittent
claudication is:
1.
2.
3.
4.
Leg pain that happens with exercise.

Leg pain that occurs at rest.
Pain that can occur anywhere in the body with exercise.
A tingling feeling in the hands.
Correct Answer: Leg pain that happens with exercise.

Rationale: Intermittent claudication is exercise-induced leg pain that can occur in
different locations throughout the leg/hip area. While the pain can eventually occur at
rest, the disease process has worsened significantly at that point. The pain is unique to the
lower extremities.
Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
LO: 1
3. A diabetic 68-year-old female client arrives at the clinic with a history of smoking,
hypertension, family history of cardiac disease, COPD, and admits to rarely exercising.
The nurse identifies which of the following risk factors most closely associated with
peripheral arterial disease?
1. Hypertension and smoking
2. COPD and family history of cardiac disease
3. Sedentary lifestyle and diabetes
4. Age and gender
Correct Answer: Hypertension and smoking
Rationale: Hypertension and smoking, along with diabetes, are the top risk factors for
developing PAD. The other correlating factors are family history and sedentary lifestyle,
but to a lesser degree. COPD and diabetes, as well as the clients age and gender, are not
closely related to development of PAD.
Cognitive Level: Analysis
LO: 1
4. A client with peripheral arterial disease has a nursing diagnosis of Ineffective Tissue
Perfusion. Which one of the following nursing interventions is most appropriate for this
nursing diagnosis?
1.
2.
3.
4.
Do not elevate the clients legs.

Assist the client in taking hot baths.
Encourage the client to limit activity.
Limit visitors.
Correct Answer: Do not elevate the clients legs.

Rationale: Keeping a clients legs in the dependent position, and not elevating the legs,
will help increase the arterial circulation. A client with PAD should avoid extremes in
temperature and avoid a hot bath or cold weather. Activity should be encouraged, not
discouraged. There is no need to limit visitors.
LO: 2
5. The client who has been diagnosed with PAD has a nursing diagnosis of Risk for
Impaired Skin Integrity related to decreased peripheral circulation. Which of the
following interventions is most appropriate for this client?
1. Instruct client on protecting the legs from injury because tissue is fragile and any
wound is likely to heal slowly.
2. Instruct client on appropriate level of activity to promote circulation.
3. Instruct client on risk factors that may increase problems with PAD.
4. Instruct client on PAD signs and symptoms.
Correct Answer: Instruct client on protecting the legs from injury because tissue is fragile
and any wound is likely to heal slowly.
Rationale: The client with risk for impaired skin integrity related to decreased peripheral
circulation will need instruction on protecting the legs from injury. Any wound the client
acquires is likely to heal slowly. The client will need instruction on the appropriate level
of activity, risk factors, and signs and symptoms of PAD, but these do not relate to risk
for impaired skin integrity.
LO: 2
6. A client with peripheral arterial disease (PAD) is a smoker. The nurse has established a
nursing diagnosis of Deficient Knowledge of self-care needs and treatment plan related to
tobacco use. Which one of the following interventions should the nurse choose to
implement?
1.
2.
3.
4.
Discuss with the client a smoking cessation plan.

Encourage the client to take medication.
Instruct the client in increasing exercise.
Discuss the clients use of herbal therapies.
Correct Answer: Discuss with the client a smoking cessation plan.

Rationale: It is critical for the clients who smoke to stop smoking to improve their
outcomes. A smoking cessation plan should be implemented and follow-up instituted
after the client quits smoking. Medication, increasing exercise, and herbal therapies may
be a part of the cessation plan.
LO: 2
7. A client with Raynauds disease presents with symptoms of pallor of the fingers. The
client states that her hands turn white, then blue, then red. The nurse instructs the client
that these symptoms are a result of:
1. The vasospasm of the small arteries and arterioles in the hands.
2. Inflammation of the small vessels of the hands and feet with eventual
formation of small clots.
3. Atherosclerosis caused by too many circulating lipids.
4. Bleeding in the interior portion of the hands.
Correct Answer: The vasospasm of the small arteries and arterioles in the hands.
Rationale: A client with Raynauds disease has symptoms from vasospasm of the small
arteries and arterioles in the hands. Inflammation of the small vessels of the hands and
feet, with eventual formation of small clots, is the cause of Buergers disease. Neither
Buergers nor Raynauds is caused by atherosclerosis or bleeding.
LO: 3
8. The nurse notes that the client with Raynauds disease is more anxious than usual and
states, I dont understand why my hands keep turning colors. It seems to happen when I
get upset. The nurses most appropriate response is to:
1. Discuss how stress can cause the vasospasms in Raynauds disease and
develop a plan to manage stress.
2. Discuss using hot water to warm up the clients hands and keep them warm.
3. Implement a no-visitor policy to keep the client calmer.
4. Discuss how Raynauds can impact the clients health.
Correct Answer: Discuss how stress can cause the vasospasms in Raynauds disease and
develop a plan to manage stress.
Rationale: Stress is related to Raynauds symptoms, and the client should be taught how
to manage stress. The client should know how to keep the hands warm, but hot water is
not advised. There is no need to implement a no-visitor policy; the client must learn to
manage everyday stressors in order to manage the disease.
LO: 3
9. A 48-year-old male who smokes has just been diagnosed with Buergers disease. The
nurses top priority prior to discharge of this client is to instruct the client on:
1. Smoking cessation.
2. Avoiding hot climates.
3. Increasing the clients activity level.
4. Decreasing the clients anxiety.
Correct Answer: Smoking cessation.
Rationale: Buergers disease is primarily affiliated with the use of tobacco products;
therefore, the nurses primary focus is providing instruction on smoking cessation and
avoidance of all tobacco products. The client may also need to avoid cold temperature,
which may make the symptoms worse. Increasing the clients activity level and
decreasing the clients anxiety are not a top priority.
LO: 3
10. The client is scheduled for an endovascular repair. The nurse is providing
preoperative instructions for this procedure. The client asks where the incision will be
located. The nurse replies:
1. There will be a small incision in the groin area because the procedure is done
via the femoral artery.
2. There will be an incision in the abdomen because the surgeon will need access
to the abdomen.
3. There will be an incision in the mid-chest because the surgeon will need to
perform bypass surgery.
4. There will be no incisions because the repair is done via IV access.
Correct Answer: There will be a small incision in the groin area because the procedure is
done via the femoral artery.
Rationale: The endovascular repair is completed via the femoral artery, so a small
incision in the groin may be necessary. Depending upon the location of the aneurysm, the
surgeon may need access to different locations, which would require an open surgical
repair. These surgeries are not considered endovascular. There is never a repair utilizing
an IV access, since this is on the venous side, not the arterial.
LO: 4
11. A client who has just completed an endovascular repair of the aorta is now
complaining of numbness and tingling in his toes. The nurse inspects the clients legs and
discovers weak pulses bilaterally, cool lower extremities, and capillary refill greater than
3 seconds. The nurse should immediately:
1. Contact the health care provider because the client has likely developed a
thrombus, blocking the artery.
2. Contact the clients family to come to the hospital.
3. Instruct the client to take deep breaths to increase oxygenation.
4. Contact the ECG technician to get an ECG because the client is likely having
a heart attack.
Correct Answer: Contact the health care provider because the client has likely developed
a thrombus, blocking the artery.
Rationale: Because the client is experiencing numbness, tingling, weak pulses, and signs
of poor perfusion, the client is likely experiencing a thrombus that is blocking the femoral
arteries. The health care provider will need to be contacted immediately to evaluate the
client. Contacting the clients family should only be done if the client wishes, but this is
not the priority. Instructing the client to take deep breaths will increase oxygenation, but
will not impact the blood flow to the lower extremities. The client is not having a heart
attack; therefore, completing an ECG is not necessary.
Nursing Process: Evaluation
LO: 4
12. A client who is a fresh postoperative endovascular repair is complaining of numbness

and tingling in his right foot. The nurse checks for pedal pulses and finds one only in the
left foot. The right foot is cool and pale. What is the next step for the nurse to take?
1.
2.
3.
4.
Contact the health care provider.

Take the clients blood pressure.
Listen to the clients lungs.
Provide the client with pain medication.
Correct Answer: Contact the health care provider.

Rationale: The fresh postoperative client who has undergone an endovascular repair is at
risk for distal embolization. The lack of pedal pulse and a cool, pale right foot is
indicative of a clot, and the health care provider should be contacted. Taking the clients
blood pressure and assessing the lung sounds will need to be done, but are not a top
priority. Providing the client with pain medication is not necessary at this time.
LO: 4
13. A client with a deep venous thrombosis (DVT) is going home on warfarin
(Coumadin). The nurse instructs the client that lab work will need to be drawn frequently
until the levels stabilize. For which lab results will the clients warfarin need to be
adjusted?
1.
2.
3.
4.
INR of 1.3
INR of 2.1
INR of 2.8
INR of 3.0
Correct Answer: INR of 1.3

Rationale: The ideal INR range for a client on warfarin is 2.0 to 3.0. An INR of 1.3 will
require warfarin to be increased. The INRs of 2.1, 2.8, and 3.0 are within therapeutic
range.
Nursing Process: Evaluation
LO: 5
14. A number of clients on the unit are at risk for deep venous thrombosis (DVT). The
client who has _____________ has the highest risk.
1.
2.
3.
4.
Had a hip replacement

Had a mole removed
Had dental surgery
Pneumonia
Correct Answer: Had a hip replacement

Rationale: An orthopedic surgical client has a 40% to 60% risk of developing a DVT. A
mole repair and dental surgery have minimal risks for DVT. A client with pneumonia has
an increased risk for DVT due to immobility.
LO: 5
15. A 150-pound male 38-year-old client has been diagnosed with deep venous
thrombosis (DVT). The clients history includes recent cardiac bypass surgery, working
in a pesticide plant, and hypertension. The family is asking what risk factors the client
may have that put him at risk for DVTs. The nurse responds by telling the family that:
1. His recent surgery and prolonged immobilization are risk factors.
2. His prior employment in the pesticide plant may have contributed to the DVT.
3. The cause for DVTs is unknown, but probably is related to his weight.
4. The clients hypertension is a major contributor to the development of DVTs.
Correct Answer: His recent surgery and prolonged immobilization are risk factors.
Rationale: Prolonged immobilization and the recent heart surgery have contributed to the
clients DVTs. Obesity can contribute to developing DVTs, but this clients weight is 150
pounds. Working in a pesticide plant has no known correlation to the development of
DVTs. Hypertension does not play a direct role in DVTs.
LO: 5
16. A client on clopidogrel (Plavix) is receiving discharge instructions. The nurse

correctly tells the client to:
1.
2.
3.
4.
Take the medication with food.

Take the medication on an empty stomach.
Have PT drawn frequently.
Be aware of food interactions with the medication.
Correct Answer: Take the medication with food.

Rationale: Clopidogrel should be taken with food. A PT is drawn for warfarin, not
clopidogrel. Food interactions are more common with warfarin. However, clopidogrel
does interact with NSAIDs, diltiazem, vitamin A, and anticoagulants and should be
monitored for drug efficacy.
LO: 6
17. A client is receiving enoxaparin (Lovenox). The client is scheduled for surgery. The
nurse visits with the anesthesia care provider to ensure that the client:
1.
2.
3.
4.
Will not be receiving an epidural.

Will have correct body alignment.
Will not receive medications that interact with enoxaparin.
Is informed of the procedure.
Correct Answer: Will not be receiving an epidural.

Rationale: An epidural is contraindicated with clients receiving enoxaparin. The surgical
department will ensure correct body alignment. The nurse will ensure the client has
received information regarding the procedure, but would not contact anesthesia regarding
this. Medication interaction is not common with enoxaparin.
LO: 6
18. The client with DVT is receiving enoxaparin (Lovenox) and will be discharged with
this drug. The nurse is providing discharge instructions for the client. Which of the
following would be information the nurse will provide regarding enoxaparin?
1. Leave the air bubble in the syringe when injecting the medication.
2. This drug is given IM.
3. The client will need to return to the clinic weekly to have lab work drawn.
4. The client will need to inject this drug every 2 to 4 hours.
Correct Answer: Leave the air bubble in the syringe when injecting the medication.
Rationale: The enoxaparin comes prepackaged with a bubble already in the syringe. The
bubble needs to remain in the syringe when injected so that the medication is all given
into the tissue. Enoxaparin is given subcutaneous, not intramuscular. No lab work is
required for enoxaparin on an ongoing basis. Enoxaparin is typically given one to two
times per day.
LO: 6
19. The nurse is conducting a community class on the prevention of varicose veins. The
nurse discusses which of the following with the class?
1.
2.
3.
4.
Avoid long periods of standing or sitting in one position.

Gaining weight may help with minimizing risks of varicose veins.
Place the feet in a dependent position to help with circulation.
Avoid exercise such as walking that might increase stress on the legs.
Correct Answer: Avoid long periods of standing or sitting in one position.

Rationale: The nurse should advise the class to avoid any activity that will create pooling
of the venous system, such as sitting or standing for extended periods of time. The client
should also lose weight if appropriate, not gain weight. Placing the feet in a dependent
position will help with arterial circulation, not venous. Intermittent exercise will help
increase venous return.
LO: 7
20. A client who is pondering having surgical repair of varicose veins asks the nurse how
long the hospital stay would be with that procedure. The nurse responds:
1. The procedure is performed as an outpatient. There is no inpatient stay.
2. The procedure is completed over several days. The client will be asked to
come back every day to an outpatient setting.
3. The procedure is an inpatient procedure that requires an overnight stay.
4. The procedure is a complicated procedure and will require at least 2 days in
the hospital.
Correct Answer: The procedure is performed as an outpatient. There is no inpatient stay.
Rationale: Surgical repair of varicose veins is usually a one-time outpatient procedure
and does not require inpatient care.
LO: 7
21. The nurse is educating a group of individuals on varicose veins. The nurse is asked
how someone can avoid getting varicose veins. The nurse tells the group:
1. The best method to avoid varicose veins is to prevent them by maintaining ideal
body weight, avoiding prolonged standing, and getting regular exercise.
2. Getting varicose veins is hereditary, so nothing a person does can stop them.
3. Varicose veins are the result of blocked arteries, so increasing exercise will help.
4. Wearing tight clothing will help prevent varicose veins.
Correct Answer: The best method to avoid varicose veins is to prevent them by
maintaining ideal body weight, avoiding prolonged standing, and getting regular exercise.
Rationale: Avoiding prolonged standing, maintaining an ideal body weight, and getting
regular exercise is the best way to prevent varicose veins. Heredity does play a role in
varicose veins, but a client may still be able to minimize them. Varicose veins are not the
result of blocked arteries. Wearing tight clothing may increase the likelihood of varicose
veins.
LO: 7
22. The client presents to the emergency department (ED) with sharp pain between the
shoulder blades. The client describes the pain as a shredding pain. The nurse recognizes
that this problem often mimics a myocardial infarction (MI) or pulmonary embolism
(PE). She knows that, unlike an MI client, this client will likely have which of the
following tests performed?
1.
2.
3.
4.
CT scan of the chest/abdomen

Troponin
ECG
Echocardiogram
Correct Answer: CT scan of the chest/abdomen

Rationale: A CT scan of the chest/abdominal area will reveal a dissecting aneurysm, but
is not helpful for determination of an MI. Troponin and ECG will be done to rule out an
MI. An echocardiogram may be done for both an MI or dissecting aneurysm.
Nursing Process: Planning
LO: 8
23. A client who has had a dissecting aneurysm repaired is being prepared for discharge.
The client has a history of hypertension. The nurse is careful to explain to the client the
importance of:
Select all that apply.
1. Keeping the blood pressure well managed.
2. Not running out of blood pressure medication.
3. Taking the clients pulse.
4. Managing the incision.
5. Not drinking too much fluid.
Correct Answer:
1. Keeping the blood pressure well managed.
2. Not running out of blood pressure medication.
Rationale: Keeping the blood pressure well managed. It is critical to keep the clients
blood pressure under control. Not running out of blood pressure medication. It is
critical for the client to take medication as instructed. Taking the clients pulse. Taking
the clients pulse should not be an issue. Managing the incision. Managing an incision
should not be an issue. Not drinking too much fluid. There isnt likely to be a fluid
restriction for the client.
LO: 8
24. A client presents to the emergency department with complaints of feeling like
something is ripping in my chest and sudden onset of mid-back pain. The client has a
history of hypertension. What is the top priority for this client?
1. Facilitate an immediate CT scan.
2. Provide pain medication.
3. Contact the clients family.
4. Obtain a surgical history.
Correct Answer: Facilitate an immediate CT scan.
Rationale: Rapid diagnosis for this client is imperative and may mean the difference
between life and death. Facilitating an immediate CT or other diagnostic study will help
with a diagnosis. The client will need pain medication, but it can be provided after the CT
arrangements have been made. Contacting the clients family and obtaining a surgical
history are not top priorities for this client, but will need to also be accomplished.
LO: 8

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[Osborn] chapter 43

Learning Outcomes [Number and Title ]

Leg pain that happens with exercise.

Correct Answer: Leg pain that happens with exercise.

Do not elevate the clients legs.

Correct Answer: Do not elevate the clients legs.

Discuss with the client a smoking cessation plan.

Correct Answer: Discuss with the client a smoking cessation plan.

12. A client who is a fresh postoperative endovascular repair is complaining of numbness

Contact the health care provider.

Correct Answer: Contact the health care provider.

Correct Answer: INR of 1.3

Had a hip replacement

Correct Answer: Had a hip replacement

16. A client on clopidogrel (Plavix) is receiving discharge instructions. The nurse

Take the medication with food.

Correct Answer: Take the medication with food.

Will not be receiving an epidural.

Correct Answer: Will not be receiving an epidural.

Avoid long periods of standing or sitting in one position.

Correct Answer: Avoid long periods of standing or sitting in one position.

CT scan of the chest/abdomen

Correct Answer: CT scan of the chest/abdomen

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