Peripheral Vascular Diseases Practice

Quiz (20 Questions)

Question 1
CORRECT
The most important factor in regulating the caliber of blood vessels, which determines
resistance to flow, is:

A Hormonal secretion
B Independent arterial wall activity
C The influence of circulating chemicals
The sympathetic nervous system
Question 2
CORRECT
With peripheral arterial insufficiency, leg pain during rest can be reduced by:

A Elevating the limb above heart level

Lowering the limb so it is dependent

C Massaging the limb after application of cold compresses

D Placing the limb in a plane horizontal to the body
Question 3
CORRECT
Buerger’s disease is characterized by all of the following except:

A Arterial thrombosis formation and occlusion

Lipid deposits in the arteries

C Redness or cyanosis in the limb when it is dependent

D Venous inflammation and occlusion
Question 4
CORRECT
A significant cause of venous thrombosis is:

A Altered blood coagulation

B Stasis of blood
C Vessel wall injury
All of the above
Question 5
CORRECT
When caring for a patient who has started anticoagulant therapy with warfarin
(Coumadin), the nurse knows not to expect therapeutic benefits for:

A At least 12 hours
B The first 24 hours
2-3 days

D 1 week
Question 6
CORRECT
Mike, a 43-year old construction worker, has a history of hypertension. He smokes
two packs of cigarettes a day, is nervous about the possibility of being unemployed,
and has difficulty coping with stress. His current concern is calf pain during minimal
exercise that decreased with rest. The nurse assesses Mike’s symptoms as being
associated with peripheral arterial occlusive disease. The nursing diagnosis is
probably:
Alteration in tissue perfusion related to compromised
circulation

B Dysfunctional use of extremities related to muscle spasms

C Impaired mobility related to stress associated with pain
D Impairment in muscle use associated with pain on exertion
Question 7
CORRECT
A 24-year old man seeks medical attention for complaints of claudication in the arch
of the foot. A nurse also notes superficial thrombophlebitis of the lower leg. The nurse
would next assess the client for:

A Familial tendency toward peripheral vascular disease

Smoking history

C Recent exposures to allergens

D History of insect bites
Question 7 Explanation: The mixture of arterial and venous manifestations
(claudication and phlebitis, respectively) in the young male client suggests Buerger’s
disease. This is an uncommon disorder characterized by inflammation and thrombosis
of smaller arteries and veins. This disorder typically is found in young adult males
who smoke. The cause is not known precisely but is suspected to have an autoimmune
component.

Question 8
CORRECT
Intravenous heparin therapy is ordered for a client. While implementing this order, a
nurse ensures that which of the following medications is available on the nursing
unit?

A Vitamin K
B Aminocaproic acid
C Potassium chloride
Protamine sulfate

Question 8 Explanation: The antidote to heparin is protamine sulfate and should be

readily available for use if excessive bleeding or hemorrhage should occur

Question 9
CORRECT
A client who has been receiving heparin therapy also is started on warfarin sodium
(coumadin). The client asks the nurse why both medications are being administered.
In formulating a response, the nurse incorporates the understanding that warfarin
sodium:
Stimulates the breakdown of specific clotting factors by the
A liver, and it takes 2-3 days for this is exhibit an
anticoagulant effect.
Inhibits synthesis of specific clotting factors in the liver,
and it takes 3 to 4 days for this medication to exert an
anticoagulation effect.
Stimulates production of the body’s own thrombolytic
C substances, but it takes 2-4 days for it to begin.
Has the same mechanism action of heparin, and the crossover time
D is needed for the serum level of warfarin sodium to be
therapeutic.

Question 9 Explanation: Warfarin sodium works in the liver and inhibits synthesis
of four vitamin K-dependent clotting factors (X, IX, VII, and II), but it takes 3 to 4
days before the therapeutic effect of warfarin is exhibited.
Question 10
CORRECT
A nurse has an order to begin administering warfarin sodium (coumadin) to a client.
While implementing this order, the nurse ensures that which of the following
medications is available on the nursing unit as the antidote for Coumadin?
Vitamin K

B Aminocaproic acid
C Potassium chloride
D Protamine sulfate
Question 10 Explanation: The antidote to warfarin (Coumadin) is Vitamin K and
should be readily available for use if excessive bleeding or hemorrhage should occur.

Question 11
CORRECT
A nurse is assessing the neurovascular status of a client who returned to the surgical
nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is
warm, and the nurse notes redness and edema. The pedal pulse is palpable and
unchanged from admission. The nurse interprets that the neurovascular status is:
Normal because of the increased blood flow through the leg

B Slightly deteriorating and should be monitored for another hour

C Moderately impaired, and the surgeon should be called.
Adequate from the arterial approach, but venous complications
D are arising.
Question 11 Explanation: An expected outcome of surgery is warmth, redness, and
edema in the surgical extremity because of increased blood flow. Options 2, 3, and 4
are incorrect interpretations.

Question 12
CORRECT
A client is admitted with a venous stasis leg ulcer. A nurse assesses the ulcer,
expecting to note that the ulcer:

A Has a pale colored base

B Is deep, with even edges
C Has little granulation tissue
Has brown pigmentation around it

Question 12 Explanation: Venous leg ulcers, also called stasis ulcers, tend to be
more superficial than arterial ulcers, and the ulcer bed is pink. The edges of the ulcer
are uneven, and granulation tissue is evident. The skin has a brown pigmentation from
accumulation of metabolic waste products resulting from venous stasis. The client
also exhibits peripheral edema. (options 1, 2, and 3 are due to tissue malnutrition; and
thus us an arterial problem)

Question 13
CORRECT
In preparation for discharge of a client with arterial insufficiency and Raynaud’s
disease, client teaching instructions should include:

A Walking several times each day as an exercise program.

Keeping the heat up so that the environment is warm

C Wearing TED hose during the day

D Using hydrotherapy for increasing oxygenation
Question 13 Explanation: The client’s instructions should include keeping the
environment warm to prevent vasoconstriction. Wearing gloves, warm clothes, and
socks will also be useful when preventing vasoconstriction, but TED hose would not
be therapeutic. Walking would most likely increase pain.

Question 14
CORRECT
A client comes to the outpatient clinic and tells the nurse that he has had legs pains
that began when he walks but cease when he stops walking. Which of the following
conditions would the nurse assess for?

A An acute obstruction in the vessels of the legs

Peripheral vascular problems in both legs

C Diabetes
D Calcium deficiency
Question 14 Explanation: Intermittent claudication is a condition that indicates
vascular deficiencies in the peripheral vascular system. If an obstruction were present,
the leg pain would persist when the client stops walking. Low calcium levels may
cause leg cramps but would not necessarily be related to walking.

Question 15
CORRECT
Which of the following characteristics is typical of the pain associated with DVT?

A Dull ache
B No pain
Sudden onset

D Tingling
Question 15 Explanation: DVT is associated with deep leg pain of sudden onset,
which occurs secondary to the occlusion. A dull ache is more commonly associated
with varicose veins. A tingling sensation is associated with an alteration in arterial
blood flow. If the thrombus is large enough, it will cause pain.

Question 16
CORRECT
Cancer can cause changes in what component of Virchow’s triad?
Blood coagulability

B Vessel walls
C Blood flow
D Blood viscosity
Question 17
CORRECT
Varicose veins can cause changes in what component of Virchow’s triad?

A Blood coagulability
B Vessel walls
Blood flow

D Blood viscosity
Question 18
CORRECT
Which technique is considered the gold standard for diagnosing DVT?
A Ultrasound imaging
Venography

C MRI
D Doppler flow study
Question 19
CORRECT
A nurse is assessing a client with an abdominal aortic aneurysm. Which of the
following assessment findings by the nurse is probably unrelated to the aneurysm?

A Pulsatile abdominal mass

Hyperactive bowel sounds in that area

C Systolic bruit over the area of the mass

D Subjective sensation of “heart beating” in the abdomen
Question 19 Explanation: Not all clients with abdominal aortic aneurysms exhibit
symptoms. Those who do describe a feeling of the “heart beating” in the abdomen
when supine or be able to feel the mass throbbing. A pulsatile mass may be palpated
in the middle and upper abdomen. A systolic bruit may be auscultated over the mass.
Hyperactive bowel sounds are not related specifically to an abdominal aortic
aneurysm.

Question 20
CORRECT
A nurse is caring for a client who had a percutaneous insertion of an inferior vena
cava filter and was on heparin therapy before surgery. The nurse would inspect the
surgical site most closely for signs of:

A Thrombosis and infection

Bleeding and infection

C Bleeding and wound dehiscence

D Wound dehiscence and evisceration
Question 20 Explanation: After inferior vena cava insertion, the nurse inspects the
surgical site for bleeding and signs and symptoms of infection. Otherwise, care is the
same as for any post-op client.
1. A patient has an arterial ulcer on the lower extremity. What risk factors for
peripheral arterial disease are in the patient's health history? Select all that apply:

A. Pregnancy

B. Being Female

C. High Cholesterol

D. Diabetes Mellitus

E. Uncontrolled hypertension

F. Varicose veins

G. Smoking

The answers are C, D, E, and G. High cholesterol, diabetes mellitus, uncontrolled

hypertension, and smoking are risk factors for peripheral arterial disease (PAD).
Pregnancy, being female, varicose veins are risk factors for peripheral venous disease.

2. Your patient is diagnosed with Buerger's Disease (thromboangiitis obliterans). The

nurse will make it priority to educate the patient about implementing?

 A. Low fat diet

 B. Blood glucose control

 C. Smoking cessation

 D. Blood pressure control

The answer is C. The most common cause of Buerger's Disease (thromboangiities obliterans)
is tobacco usage (smoking). Buerger's Disease occurs when the blood vessels of the hands
and feet become inflamed and clots form. The clots will block blood flow. The nurse should
make it priority to educate the patient on smoking cessation.

3. A patient is diagnosed with Raynaud's Disease. Which explanations below most

accurately describe this condition? Select all that apply:

 A. Raynaud's Disease is triggered by cold temperatures or stress.

 B. Raynaud's Disease occurs due to a vasospasm of the peripheral veins.

 C. Raynaud's Disease affects the toes, fingers, and sometimes the ears and

nose.

 D. Raynaud's Disease is prevented by glucose control.

The answers are A and C. Raynaud's Disease occurs when vasospasm of peripheral arteries
occurs. It mainly affects the fingers and toes (it can also affect the ears/nose). It
is triggered by exposure to cold or during stress. It can be prevented by keeping the
toes, fingers, ears, and nose warm and avoid stress. Medications can also be used as
well that help prevent vasospasm.

4. True or False: Peripheral arterial disease leads to a decrease in rich oxygenated

blood being delivered to the lower extremities, which leads to ischemia and necrosis
of skin tissue.

 True

 False

The answer is TRUE.

5. The MOST common cause of peripheral arterial disease is?

 A. Diabetes

 B. Deep vein thrombosis

 C. Atherosclerosis

 D. Pregnancy

The answer is C. Atherosclerosis is the most common cause of PAD (peripheral arterial
disease). This is the collection of fatty plaques on the artery wall. This blocks blood
flow.

6. True or False: Peripheral venous disease can occur due to narrowing of the valves
in the veins of the lower extremities.

 True

 False

The answer is FALSE. Peripheral venous disease can occur due to overstretched valves
of the veins (NOT narrowed) in the lower extremities. In addition, it can occur when
the veins become damaged.

7. Your patient reports experiencing dull and achy sensations in the lower extremities.
You note that the lower extremities have edema and brownish pigmentation. Pulses are
present bilaterally and the extremities feel warm to the touch. To help alleviate the
patient’s symptoms, the nurse will position the lower extremities in the?

 A. Dependent position

 B. Horizontal position

 C. Elevated position above heart level

 D. Knee-flexed position
The answer is C. Based on the signs and symptoms in the scenario above, the patient is
experiencing peripheral VENOUS disease. The blood is stagnant (or static) in the lower
extremities and can’t flow back to the heart. Therefore, the patient is experiencing
dull and achy sensations along with edema and brownish pigmentation. The nurse should
place the patient’s lower extremities in the elevated position above the heart to help
facilitate blood return to the heart and alleviate the pain.

8. You’re assessing a patient’s health history for peripheral vascular disease. What
signs and symptoms reported by the patient would indicate the patient may be
experiencing peripheral arterial disease? Select all that apply:

 A. “I often wake up at night with leg pain and have to dangle my leg out of

the bed to ease the pain.”

 B. “If I stand or sit too long my legs start to feel heavy and achy.”

 C. “It hurts to elevate my legs.”

 D. “Sometimes when I’m walking my legs start to cramp and tingle to the point

where I can’t walk until the pain goes away.”

The answers are A, C, and D. Peripheral arterial disease occurs when there is impediment
of blood flow to the lower extremities (hence the lower extremities are being deprived
of blood flow and this causes pain). The pain most commonly occurs at night and can wake
up the patient. It is known as “rest pain”. This occurs because when the legs are
horizontal the blood flow is compromised and it causes pain…therefore the patient will
report they dangle the leg off the bed to help ease the pain (the dependent position
(dangling) will help blood flow down to the extremity). In addition, it hurts to elevate
the legs (again because this further compromises blood flow). Option B occurs in
peripheral venous disease. Option C is known as intermittent claudication and is a
HALLMARK sign and symptom in PAD.

9. Your patient has severe peripheral arterial disease. When the lower extremities are
elevated you would expect them to appear _______________ and, when they are in the
dependent position you would expect them to appear _________________. Fill in the
blanks:

 A. cyanotic; rubor

 B. rubor; pallor

 C. cyanotic, pallor

 D. pallor; rubor

The answer is D. In severe PAD, if the lower extremities are elevated they will turn
pale (pallor). However, if they are in the dependent position (dangling) they will appear
rubor (red and warm…this occurs due to inflammation of the vessels).

10. A patient has severe peripheral venous disease. What important information below
will the nurse provide to the patient about how to alleviate signs and symptoms
associated with the disease? Select all that apply:
  A. Elevate the lower extremities below heart level frequently

 B. Application of compression stockings

 C. Limit long periods of standing and sitting

 D. Use the knee-flexed position while lying in bed

The answers are B and C. The patient with peripheral VENOUS disease should elevate the
lower extremities ABOVE heart level (this helps return blood to the heart and decrease
swelling/pain), avoid crossing the legs (or the knee-flexed position) because this
impedes blood flow, and limit long periods of standing and sitting (this limits blood
return to the heart and increases swelling). In addition, the application of compression
stockings is very beneficial in peripheral venous disease because it helps blood return
to the heart and prevents the stasis of blood in the lower extremities.

11. Your patient has severe peripheral venous disease. During the head-to-toe nursing
assessment, you would expect to find what skin characteristics of the lower extremities?
Select all that apply:

 A. Thick, tough

 B. Thin, scaly

 C. Hairless

 D. Brown pigmented

The answers are A and D. This is commonly found in severe peripheral venous disease.
Options B and C are found in peripheral ARTERIAL disease.

12. Your patient has returned from a peripheral artery bypass for the treatment of
peripheral arterial disease. The nurse will make it PRIORITY to?

 A. Assess the surgical site for excessive drainage

 B. Assess and grade lower extremity pulses bilaterally

 C. Apply compression stockings

 D. Elevate the lower extremity above heart level

The answer is B. A peripheral artery bypass is performed to treat severe cases of PAD.
The surgeon will "bypass" the blockage in the lower extremity and have blood flow
re-routed around the blockage. This will provide blood flow back to the lower extremity.
It is PRIORITY that the nurse assesses and grades the lower extremity pulses bilaterally
frequently. If the pulses diminish or become absent the nurse should notify the physician
immediately.
13. A patient has an ulcer on the medial malleolus. The ulcer is shallow with irregular
edges. The wound base is red. Wound drainage is also present. What type of ulcer is
this based on the scenario’s description?

 A. venous ulcer

 B. arterial ulcer

 C. diabetic ulcer

The answer is A. These findings are associated with a venous ulcer.

14. Select below all the characteristics that can present with an arterial ulcer:

 A. Found on the lateral malleolus, dorsum of foot, or end of toes

 B. Found on the medial malleolus or medial part of lower leg

 C. Deep, round, defined edges and has a “punched out” appearance

 D. Minimal drainage

 E. Edematous

 F. Brown pigmented skin surrounding the ulcer

 G. Wound base is pale

The answers are A, C, D, and G. Arterial ulcers have very little blood flow to them so
they will be pale (little granulation) and have little (if any) drainage. They will be
deep, round, and have a “punched out” appearance. They are most commonly found on the
lateral malleolus, dorsum of foot, or end of toes.

15. You're providing discharge teaching to a patient with peripheral arterial disease.
Which statement by the patient requires you to re-educate the patient?

 A. "It is important I quit smoking."

 B. "To prevent my feet and legs from getting too cold at night, I will use a
heating pad.

 C. "A walking program would be beneficial in treatment of my PAD."

 C. "I will avoid wearing tight socks or shoes."

The answer is B. The patient should try to prevent the feet and legs from getting too
cold because this causes vasoconstriction, which impedes blood flow further. Therefore,
they should dress warmly with LOOSE layers. However, they should AVOID using heating
pads because of the reduce of sensation from compromised blood flow. A walking program
is a great way to prevent intermittent claudication, lower the cholesterol, and improve
oxygen levels in the blood….which are all great ways of treating PAD.