Olivia McRitchie
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NCLEX Nursing (Medical-Surgical) Quiz on Exemplar 16.9: Peripheral Vascular Disease, created by Olivia McRitchie on 04/12/2018.

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Olivia McRitchie
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Exemplar 16.9: Peripheral Vascular Disease

Exemplar 16.9: Peripheral Vascular Disease

Question 1 of 10

1

You have a student nurse caring for a patient with peripheral vascular disease from atherosclerosis. She doesn't quite know what that is because she hasn't gotten to that exemplar in her med-surg class yet.

Select the correct teaching you can give the student.

Select one of the following:

  • "Atherosclerosis occurs more often in the upper extremities, whereas chronic venous insufficiency occurs more often in the lower extremities."

  • "Plaque is unlikely to form at arterial bifurcations because there's too much blood flow."

  • "Atherosclerosis occurs when deposits of fat and fibrin obstruct and harden the arteries."

  • "Atherosclerosis causes the skin to atrophy and the subcutaneous fat deposits to necrose."

Explanation

Question 2 of 10

1

You have 52-year-old patient with chronic venous insufficiency (CVI) from having a desk job for 35 years. She doesn't know what that is, and asks you to explain it.

Which of the following statements made by the patient shows that more teaching is needed?

Select one of the following:

  • "CVI caused by venous blood collecting and staying in the lower leg."

  • "CVI is causing the tissues on my leg to turn brown and my skin to sag."

  • "CVI is the reason this huge wound above my ankle isn't healing."

  • "If CVI isn't fixed, it could cause me to have an aneurysm ."

Explanation

Question 3 of 10

1

Select the clinical manifestations of peripheral atherosclerosis.

Select one or more of the following:

  • Intermittent claudication

  • A burning sensation in the lower legs that occurs during inactivity.

  • Cold, numb legs.

  • Decreased or absent peripheral pulses.

  • Pallor and pain during leg elevation, pain relief and red skin when legs are dependent.

  • Thin, shiny, hairless skin; thickened toenails; and areas of skin discolorations or breakdown.

  • Leg edema and itching, dull discomfort or pain that worsens with standing.

  • Thin, shiny, atrophic skin.

  • Cyanosis and brown pigmentation of lower lower leg and foot.

  • Thick, fibrous, hard subcutaneous tissue.

Explanation

Question 4 of 10

1

Select the clinical manifestations of chronic venous insufficiency.

Select one or more of the following:

  • Lower extremity edema and dull, itching leg discomfort or pain that worsens with standing.

  • Thin, shiny, atrophic skin.

  • Cyanosis and brown skin pigmentation of lower leg and foot.

  • Eczema ("weeping dermatitis") or stasis dermatitis

  • Thick, fibrous subcutaneous tissue that makes the leg feel somewhat leathery to the touch

  • Recurrent, poorly healing ulcerations of medial or anterior ankle.

  • Intermittent claudication

  • Burning sensation that increases when the individual is inactive and have elevated legs.

  • Cold, numb legs with decreased sensation.

  • Diminished or absent peripheral pulses.

Explanation

Question 5 of 10

1

You are in a doctor's office teaching a patient about conservative management of their venous insufficiency. What advice might you give this patient?

Select one of the following:

  • Dangle at the side of the bed multiple times a day for 5-10 minutes teach time.

  • Stand at the side of the bed multiple times a day for 5-10 minutes each time.

  • Order graduated compression hosiery and wear it at least 20 hours/day.

  • Try to keep legs and feet elevated as often as possible, including at night.

Explanation

Question 6 of 10

1

You are giving a class on managing venous insufficiency. Which of the following statements made by the nurses show that teaching as been received?

Select one of the following:

  • "If the patient has acute weeping dermatitis, a wet compress of boric acid, Burow solution, or isotonic saline should be applied for 1 hour at the beginning and end of my shift, then a topical corticosteroid should be applied."

  • "I should be honest with the patient: Nothing can prevent stasis pigmentation."

  • "If my patient develops a stasis ulcer, it can be treated with a semirigid boot made of Unna paste or Gauzetex bandage."

  • "The semirigid boot must be changed at least twice a week to prevent infection."

Explanation

Question 7 of 10

1

There are no specific diagnostic tests to confirm the diagnosis of chronic venous insufficiency.

Select one of the following:

  • True
  • False

Explanation

Question 8 of 10

1

Drag and drop the diagnostic test to the description.

-: Evaluates oxygenation of tissues.

-: A treadmill is used to provide functional assessments. With PVD, pressure at the ankle may decline even further with exercise.

-: Utilizes sphygmomanometer cuffs and a Doppler device to compare blood pressures between the upper and lower extremities and within different segments of the affected extremity. With PVD, the blood pressure may be lower in the legs than in the arms.

-: Used before revascularization to locate and evaluate the extent of arterial obstruction. Involves a contrast medium being injected and vessels being visualized using fluroscopy and X-rays, unless MRI is added.

-: Uses sound wages reflected off moving RBCs within a vessel to evaluate blood flow. The impulses may be translated into an auditory signal or a graphic waveform. If PVD is significant, the waveform will become progressively flatter as the transducer is moved distally along the affected vessel.

-: Combines audible or graphic Doppler ultrasound with ultrasound imaging to identify arterial or venous abnormalities. Ultrasonic imaging provides views of the affected vessels while Doppler ultrasound evaluates blood flow. Color can be added to procedure.

Drag and drop to complete the text.

    Transcutaneous oximetry
    Stress testing
    Segmental pressure measurements
    Angiography
    Doppler ultrasound
    Duplex Doppler ultrasound

Explanation

Question 9 of 10

1

You judge that your patient is at risk for peripheral atherosclerosis, and decide it would be wise to teach her about preventing peripheral vascular disease.

Select the accurate statements you can make to this patient.

Select one or more of the following:

  • "There is not much drug treatment for peripheral atherosclerosis. The best you can do is take some aspirin."

  • "Rather than smoking cigarettes, you should utilize nicotine patches and gum."

  • "Make sure you look at your feet and ankles every night when you take off your socks."

  • "Do not utilize elastic support hose."

  • "If you are able, try getting a bed that you can raise the head on. If you are unable, elevate the head of the bed on blocks."

  • "Try to push through the leg pain so you can exercise 30-45 minutes daily."

  • "If conservative measures fail, you may need to undergo surgery, such as revascularization, endarterectomy, and bypass grafts."

  • "If conservative measures fail, you may need to undergo nonsurgical procedures such as percutaneous transluminal angioplasty, stent placement, or atherectomy."

  • "Contrary to what the internet says, there are no complementary therapies that work to prevent PVD."

Explanation

Question 10 of 10

1

Select proper interventions to enact when caring for a patient with chronic venous insufficiency.

Select one or more of the following:

  • Assess CMST and pain every 4 hours, marking pulse locations with a permanent marker.

  • Position patient with extremities elevated

  • Encourage the patient to have her family bring her heating pad.

  • Encourage the patient to have her family bring her favorite blanket and fuzzy socks.

  • Discourage the patient from crossing legs or keeping a pillow under the knees, but encourage the patient change position as often as possible.

  • Teach techniques such as relaxation and guided imagery.

  • Ask housekeeping for an egg-crate mattress, heel protectors, and a bed cradle.

  • Speak with physical therapy about implementing an appropriate ambulation schedule.

Explanation

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