MS REVIEWER - MIDTERMS 5.

True or False: Peripheral arterial disease

leads to a decrease in rich oxygenated blood
1. A patient has an arterial ulcer on the lower
being delivered to the lower extremities,
extremity. What risk factors for peripheral
which leads to ischemia and necrosis of skin
arterial disease are in the patient’s health
tissue.
history? Select all that apply:
6. True or False: Peripheral venous disease can
a. Pregnancy
occur due to narrowing of the valves in the
b. Being Female
veins of the lower extremities.
c. High Cholesterol
7. The MOST common cause of peripheral
d. Diabetes Mellitus
arterial disease is?
e. Uncontrolled hypertension
a. Diabetes
f. Varicose veins
b. Deep vein thrombosis
g. Smoking
c. Atherosclerosis
2. A patient has an arterial ulcer on the lower
d. Pregnancy
extremity. What risk factors for peripheral
8. Your patient reports experiencing dull and
vascular disease are in the patient’s health
achy sensations in the lower extremities.
history? Select all that apply:
You note that the lower extremities have
a. Pregnancy
edema and brownish pigmentation. Pulses
b. Being Female
are present bilaterally and the extremities
c. High Cholesterol
feel warm to the touch. To help alleviate the
d. Diabetes Mellitus
patient’s symptoms, the nurse will position
e. Uncontrolled hypertension
the lower extremities in the?
f. Varicose veins
a. Dependent position
g. Smoking
b. Horizontal position
3. Your patient is diagnosed with Buerger’s
c. Elevated position above heart level
Disease (thromboangitis obliterans). The
d. Knee-flexed position
nurse will make it priority to educate the
9. You’re assessing a patient’s health history
patient about implementing?
for peripheral vascular disease. What signs
a. Low fat diet
and symptoms reported by the patient
b. Blood glucose control
would indicate the patient may be
c. Smoking cessation
experiencing peripheral arterial disease?
d. Blood pressure control
Select all that apply:
4. A patient is diagnosed with Raynaud’s
a. “I often wake up at night with leg pain
Disease. Which explanations below most
and have to dangle my leg out of the
accurately describe this condition? Select all
bed to ease the pain.”
that apply:
b. “If I stand or sit too long my legs start to
a. Raynaud’s Disease is triggered by cold
feel heavy and achy.”
temperatures or stress.
c. “It hurts to elevate my legs.”
b. Raynaud’s Disease occurs due to a
d. “Sometimes when I’m walking my legs
vasospasm of the peripheral veins.
start to cramp and tingle to the point
c. Raynaud’s Disease affects the toes,
where I can’t walk until the pain goes
fingers, and sometimes the ears and
away.”
nose.
d. Raynaud’s Disease is prevented by
glucose control.
10. Your patient has severe peripheral arterial 14. A patient has an ulcer on the medial
disease. When the lower extremities are malleolus. The ulcer is shallow with
elevated, you would expect them to appear irregular edges. The wound base is red.
________ and, when they are in the Wound drainage is also present. What type
dependent position you would expect them of ulcer is this based on the scenario’s
to appear ___________. Fill in the blanks. description?
a. cyanotic; rubor a. venous ulcer
b. rubor; pallor b. arterial ulcer
c. cyanotic, pallor c. diabetic ulcer
d. pallor; rubor 15. Select below all the characteristics that can
11. A patient has severe peripheral venous present with an arterial ulcer:
disease. What important information below a. Found on the lateral malleolus, dorsum
will the nurse provide to the patient about of foot, or end of toes
how to alleviate signs and symptoms b. Found on the medial malleolus or
associated with the disease? Select all that medial part of lower leg
apply: c. Deep, round, defined edges and has a
a. Elevate the lower extremities below “punched out” appearance
heart level frequently d. Minimal drainage
b. Application of compression stockings e. Edematous
c. Limit long periods of standing and f. Brown pigmented skin surrounding the
sitting ulcer
d. Use the knee-flexed position while lying g. Wound base is pale
in bed 16. You’re providing discharge teaching to a
12. Your patient has severe peripheral venous patient with peripheral arterial disease.
disease. During the head-to-toe nursing Which statement by the patient requires
assessment, you would expect to find what you to re-educate the patient?
skin characteristics of the lower a. “It is important I quit smoking.”
extremities? Select all that apply: b. “To prevent my feet and legs from
a. Thick, tough getting too cold at night, I will use a
b. Thin, scaly heating pad.
c. Hairless c. “A walking program would be beneficial
d. Brown pigmented in treatment of my PAD.”
13. Your patient has returned from a peripheral d. “I will avoid wearing tight socks or
artery bypass for the treatment of shoes.”
peripheral arterial disease. The nurse will 17. Which statement below is incorrect about a
make it PRIORITY to? deep vein thrombosis (DVT)?
a. Assess the surgical site for excessive a. “Veins that are most susceptible to a
drainage deep vein thrombosis are the peroneal,
b. Assess and grade lower extremity posterior tibial, popliteal and superficial
pulses bilaterally femoral.”
c. Apply compression stockings b. “DVTs tend to mostly occur in the lower
d. Elevate the lower extremity above heart extremities but can occur in the upper
level extremities too.”
 c. “A deep vein thrombosis in the lower 21. The nurse is assessing a patient, who has
extremity has a low probability of many risk factors for the development of a
becoming a pulmonary embolism.” DVT, for signs and symptoms of a deep vein
d. “A DVT is a type of venous thrombosis. What signs and symptoms
thromboembolism (VTE), which is a below would possibly indicate a deep vein
blood clot that starts in the vein.” thrombosis is present?
18. Select all the factors regarding a deep vein a. Cool extremity
thrombosis that are included in Virchow’s b. Decreases pulses
Triad: c. Redness
a. Hypocoagulability d. Pain
b. Atherosclerosis e. Warm extremity
c. Endothelial damage f. Swelling
d. Stasis of venous blood g. Cyanosis
e. Excessive coagulability 22. True or False: Assessment of Homan’s Sign
f. Increased venous blood flow is the most reliable indicator of a deep vein
19. Based on Virchow’s Triad, select which thrombosis.
patients below are at RISK for the 23. A patient is receiving continuous IV Heparin
development of a deep vein thrombosis? for anticoagulation therapy for the
Select all that apply: treatment of a DVT. In order for this
a. A 55-year-old male with hyperlipidemia medication to have a therapeutic effect on
and diabetes. the patient, the aPTT should be?
b. A 70-year-old female with severe a. 0.5-2.5 times the normal value range
sepsis. b. 2-3 times the normal value range
c. A 25-year-old male who uses c. 1.5-2.5 times the normal value range
intravenous drugs. d. 1-3.5 times the normal value range
d. A 65-year-old female who is post-op 24. A patient, who is receiving continuous IV
day 1 after joint replacement surgery. Heparin for the treatment of a DVT, has an
20. You’re developing a plan of care for a aPTT of 110 seconds. What is your next
patient who is at risk for the development nursing action per protocol?
of a deep vein thrombosis after surgery. a. Continue with the infusion because no
What nursing intervention below would the change is needed based on this aPTT.
nurse NOT include in the patient’s plan of b. Increase the drip rate per protocol
care to prevent DVT formation? because the aPTT is too low.
a. The patient will eat all meals out of the c. Re-draw the aPTT STAT.
bed daily by sitting in the bedside chair. d. Hold the infusion for 1 hour and
b. The nurse will apply sequential decrease the rate per protocol because
compression devices (SCDs) per the aPTT is too high
physician’s order to the patient’s lower
extremities every night at bedtime.
c. The nurse will administer per physician’s
order Enoxaparin in the subcutaneous
tissue of the abdomen.
d. The patient will ambulate daily.
25. You’re educating a patient about Warfarin d. Elevate affected extremity above heart
(Coumadin) and how it is used to treat level
blood clots. Which statements by the e. Encourage frequent ambulation
patient require you to re-educate them f. Monitor the patient’s INR level
about how this medication works? Select all g. Monitor the patient’s aPTT level
that apply: h. Apply sequential compression device
a. “This medication will help dissolve the (SCD) to the affected extremity
blood clot.” 29. A patient’s D-dimer result is <500 ng/mL.
b. “This medication will prevent another The nurse knows that the D-dimer assesses
blood clot from forming.” _______ and this result means?
c. “This medication will help prevent the a. fibrin degradation fragment; positive for
blood clot from becoming bigger in a blood clot
size.” b. platelet degradation protein; negative
d. “This medication starts working for a blood clot
immediately after the first dose.” c. clotting factors; positive for a blood clot
26. A patient is prescribed Warfarin (Coumadin) d. fibrin degradation fragment; negative
for the treatment of a blood clot. What is for a blood clot
the therapeutic INR range for this 30. True or False: Hypovolemic shock occurs
medication? where there is low fluid volume in the
a. 2-3 interstitial compartment.
b. 1-3 31. A patient who is experiencing hypovolemic
c. 4-8 shock has decreased cardiac output, which
d. 0.5-2.5 contributes to ineffective tissue perfusion.
27. Which option below is considered a positive The decrease in cardiac output occurs due
Homan’s Sign for the assessment of a deep to?
vein thrombosis (DVT)? a. An increase in cardiac preload
a. The patient reports pain when the foot b. An increase in stroke volume
is manually dorsiflexed. c. A decrease in cardiac preload
b. The patient reports pain when the foot d. A decrease in cardiac contractility
is manually plantarflexed. 32. One of your patients begins to vomit large
c. The patient experiences pain when the amounts of bright red blood. The patient is
leg is extended. taking Warfarin. You call a rapid response.
d. The patient experiences pain when the Which assessment findings indicate this
leg is flexed. patient is developing hypovolemic shock?
28. Your patient has a deep vein thrombosis in Select all that apply:
the left lower extremity. The patient is a. Temperature 104.8 ‘F
prescribed continuous IV Heparin. Select all b. Heart rate 40 bpm
the nursing interventions that are c. Heart rate 140 bpm
appropriate for this patient: d. Anxiety, restlessness
e. Urinary output 15 mL/hr
a. Apply cool compresses to affected
f. Blood pressure 70/56
extremity
g. Pale, cool skin
b. Measure leg circumference
h. Weak peripheral pulses
c. Massage affected extremity
i. Blood pressure 220/106
33. You’re providing care to a patient who has 38. Which statement below is the most
experienced a 45% loss of their fluid volume accurate about the process of osmosis?
and is experiencing hypovolemic shock. The a. Water will move from a solution with a
patient has hemodynamic monitoring and higher solute concentration to a
fluid resuscitation is being attempted. solution with a lower solute
Which finding indicates the patient is still in concentration.
hypovolemic shock? b. Water and solutes will move from a
a. Low central venous pressure lower water concentration solution to a
b. High pulmonary artery wedge pressure higher water concentration solution.
c. Elevated mean arterial pressure c. Water will move from a lower solute
d. Low systemic vascular resistance concentration solution to a higher
34. A patient is 1-hour post-op from abdominal solute concentration solution.
surgery and had lost 20% of their blood d. Water will move from a fluid of a lower
volume during surgery. The patient is water concentration to a fluid of a
experiencing signs and symptoms of higher water concentration.
hypovolemic shock. What position is the 39. The patient is experiencing hypovolemic
best for this patient? shock, the student nurse should be
a. Modified Trendelenburg corrected if he/she gets what iv fluids?
b. Trendelenburg a. plain lr
c. High Fowler’s b. plain nss
d. Supine c. d5water
35. A patient in hypovolemic shock is receiving d. 0.45%nacl
rapid infusions of crystalloid fluids. Which 40. What type of fluid below can cause increase
patient finding requires immediate nursing ICP?
action? a. 0.9% Normal Saline
a. Patient heart rate is 115 bpm b. 3% Saline
b. Patient experiences dyspnea and c. Dextrose 5% in 0.9% Normal Saline
crackles in lung fields d. 0.45% Normal Saline
c. Patient is anxious 41. What is the only fluid type that can be
d. Patient’s urinary output is 35 mL/hr administered with blood products?
36. A patient is receiving large amounts of fluids a. Lactated Ringer’s solution
for aggressive treatment of hypovolemic b. 0.45% Normal Saline
shock. The nurse makes it PRIORITY to? c. 3% Saline
a. Rapidly infuse the fluids d. 0.9% Normal Saline
b. Warm the fluids 42. Which fluid below is considered an isotonic
c. Change tubing in between bags solution but works as a hypotonic solution?
d. Keep the patient supine a. Dextrose 5% in water
37. What is the fluid compartment that is found b. Lactated Ringer’s solution
inside the blood vessels? c. Dextrose 10% in water
a. intracellular compartment d. 0.33% Normal Saline
b. interstitial compartment
c. intravascular compartment
d. transcellular compartment
43. Which patients below should not receive
Lactated Ringer’s solution? Select all that
apply:
a. A patient with a mild case of metabolic
acidosis.
b. A pre-op patient for abdominal surgery.
c. A patient experiencing hyperkalemia
d. A patient with liver failure.
44. Your patient is receiving 0.45% Normal
Saline for hypernatremia. What finding
requires you to stop the fluid and notify the
doctor?
a. decreasing sodium level
b. increased urination
c. confusion
d. polydipsia