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80 Cards in this Set

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A condition that typically begins w/ischemia of the small distal arteries & veins that progresses to more proximal arteries & mmore prevalent in men of 25-40 yrs of age & more often in the Middle & Far East than in North America in Europe.

a) Venous Thrombosis
b) Pulmonary Embolism
c) Thromboangiitis Obliterans
d) Phelmasia cerulea dolens
c) Thromboangiitis Obliterans

also known as Buergers Disease
A condition that occurs primarily in women between 15-40yrs of age which is an episodic vasoprestic disorder of small cutaneous arteries most frequently involving the fingers & toes.

a) Raynaud's Disease
b) Pulmonary Embolism
c) Thromboangiitis Obliterans
d) Phelmasia cerulea dolens
a) Raynaud's Disease

Contributing factors include occupationally related trauma/pressure to fingertips such as typists, pianists, & thiose using handheld vibrating equipment. It is also associated with collagen diseases such as rheumatoid arthritis, scleroderma, & systemic lupus erythematosus.
The most common disorder of the veins is:

a) Venous Thrombosis
b) Pulmonary Embolism
c) Thromboangiitis Obliterans
d) Varicose veins
a) Venous Thrombosis

the formation of a thrombus (clot) in association w/inflammation of the vein

classifies as "superficial" or "deep"
The patient has a palpable, firm, subcutaneous cordlike vein that is tender to the touch, reddened, warm, & a mild temperature is noted. The nurse suspects:

a) Thromboangiitis Obliterans
b) Phelmasia cerulea dolens
c) Superficial thrombophlebitis
d) Deep vein Thrombosis
Superficial thrombophlebitis

Most commmon cause in LOWER extremities is usually related to trauma of the varicose veins

Most common cause in UPPER extremities is is trauma to vein from IV therapy
A patient with unilatral leg edema, extremity pain, warm skin, & a systemic temp greater than 100.4F is most likely experiencing:

a) Thromboangiitis Obliterans
b) Varicose veins
c) Superficial thrombophlebitis
d) Deep vein Thrombosis
d) Deep vein Thrombosis

A patient with DVT may not have any symptoms

If calf is involved tenderness may be present on palpation

Most serious complication is pumnonary embolism, chronic venous insufficiency, & phlegmasia cerula dolens
A common problem in the elderly which often occurs as a result of previous episodes of DVT & can lead to venous leg ulcers.

a) Superficial Thrombosis
b) Thromboangiitis Obliterans
c)Chronic venous insufficiency
d) Pulmonary Embolism
c)Chronic venous insufficiency

Skin of lower leg is leathery with a brownish appearance, persistant edema, ecxema or stasis dermatitis is usually present & pruritis is a common complaint
Usually arises from thrombi in the deep veins of legs & may also arise in the right side of the heart, , rarely from the upper extremities & pelvic veins especially after surgery or child birth.

a) Superficial Thrombosis
b) Thromboangiitis Obliterans
c)Chronic venous insufficiency
d) Pulmonary Embolism
d) Pulmonary Embolism

Lethal PE's commonly originate in the femoral or iliac veins
Up to 40% of patients with Buerger's Disease (thromboangiitis Obliterans) also have:

a) Superficial Thrombosis
b) Raynaud's Disease
c)Chronic venous insufficiency
d) Pulmonary Embolism
b) Raynaud's Disease

As Buerger's Disease progresses, rest pain, & ishemic ulcerations develop & color as well as temperature changes in the affected limb, paresthesia, superficial thrombophlebitis & cold sensitivity may also be present.
There are no lab or diagnostic test specific to Buerger's Disease.

True?
False?
True

Diagnosis is based on age of onset, history of tobacco usage, clinical symptoms, involvment of distal vessels, presence of ischemic ulcerations, & exclusion of diabetes mellitus, autoimmune disease hypercoagulable states, & proximal source of emboli.
TX for Buerger's Disease is all of the following except:

a) cessation of tobacco usage in any form including passive smoke
b) Nicotine replacement products
c) amputations
b) Nicotine replacement products

SHOULD NOT NOT NOT be used !!!

trauma to the extremity should be avoided
Buerger's disease (Thromboangiitis Obliterans):

a) is unlike atherosclerosis in that lipid accumulation does not occur in the vessel wall.

b)
a) is much like atherosclerosis in that lipids accumulate in the vessel wall.
a) is unlike atherosclerosis in that lipid accumulation does not occur in the vessel wall.

A highly cellular & inflammatory thrombus forms inside the wall causing tissue ischemia.
Identify the statemennt that incorrectly describes conditions of Buerger's disease.

a) The disease improves when smoking is stopped
b) Nicotine replacement products should not be used.
c) Surgical revascularization is typically not an option
d) There are no laboratory or diagnostic tests specific to this disease.
e) Patients may have intermittant claudication of the feet, hands, or arms.
All of these statements are true. (just need to stop & really think about each one of these)
A vasospastic disorder of small cutaneous arteries usually of the fingers & toes which is more common in young women 15-40 years of age & of which there is no specific diagnostic test.

a) superficial thrombophlebitis
b) varicose veins
c) Raynaud's Disease
d) Chronic Venous Insufficiency
c) Raynaud's Disease

symptoms include cold, numb, throbbing, aching pain, swelling
Episodes of Raynaud's Disease are usually precipitated by all of the following with which exception?

a) emotional upsets
b) exposure to heat
c) exposure to cold
d) caffeine use
e) tobacco use
b) exposure to heat

After prolonged attacks, the skin may become thickened & nails brittle

in severe forms punctuate lesions of fingertips

advanced stages superficial gangrenous ulcers of fingertips
Medication therapy fro Raynoud's may include all of the following except:

a) calcium channel blockers
b) ergotamines
c) nifedipine-Procardia
d) diltiazem-Cardizem
b) ergotamines

Patients with Raynaud's should discontinue use of ergotamines, amphetamines, cocaine, pseudoephedrine
If symptoms of Raynaud's continues for 2 years in the absence of an associated disorder it is diagnosed as:

a) Buerger's disease
b) primary Raynaud's
c) secondary Raynaud's
d) Lupus
b) primary Raynaud's
If symptoms of Raynaud's exist in conjunction with a connective disorder or an autoimmune disease it is dignosed as:

a) Buerger's disease
b) primary Raynaud's Disease
c) secondary Raynaud's Disease
d) secondary Raynauds phenomenon
d) secondary Raynauds phenomenon
Teaching a patient with Raynaud's would include:

a) reassurance that no serious underlying disorder is present

b) explaining that the underlying cause is usually associated with an autoimmune disorder & additional test are necessary
a) reassurance that no serious underlying disorder is present
Patient's with Raynaud's may find relief of symptoms by immersing their hands in warm water to decrease vasospasm.

true?
false?
true?

warm clothing, avoidance of temperature extremes & stop consuming anything that has vasoactive effects such as tobacco, caffeine, certain medications are also recommended
Adverse effects of calcium channel blockers include all of the following except:

a) bradycardia
b) tachycardia
c) headache
d) flushing
e) dizzyness
f) peripheral edema
a) bradycardia
Sympathectomy is a treatment that is considered in advanced cases of:

a) Buerger's disease
b) varicose veins
c) Raynaud's disease
d) Chronic venous insufficiency
c) Raynaud's disease
The formation of a thrombus (clot)in association with inflammation of the vein is called:

a) venous thrombosis
b) superficial thrombophlebitis
c) deep vein thrombosis
d) embolism
a) venous thrombosis

less serious than deep vein thrombosis
Inflammation of a vein is termed:

a) venous thrombosis
b) superficial thrombophlebitis
c) deep vein thrombosis
d) Thromboangiitis Obliterans
b) superficial thrombophlebitis

occurs in aprx. 65% of all patients recieving IV therapy & often of minor significance
A thrombus in a deep vein most commonly in the iliac & femoral veins is known as:

a) venous thrombosis
b) superficial thrombophlebitis
c) deep vein thrombosis
d) embolism
c) deep vein thrombosis

occurs in at least 5% of all surgical patients & more serious than superficial thrombophlebitis because it can result in embolization of thrombi to the lungs
Identify the 3 important factors of Virchow's triad:

a) nicotine, ergotomines, caffeine
b) RBC's, WBC's, Fibrin
c) Chronic venous insufficiency, thrombi, embolization
d) venous stasis, damage of endothelium, hypercoagulability of the blood
Virchow's triad:

1. venous stasis

2. damage of endothelium
(inner lining of the vein)

3. hypercoagulability of the blood

The patient at risk for the development of venous thrombosis usually has predisposing conditions to these 3 disorders
Virchow's triad is associated with:

a) superficial thrombophlebitis
b) deep vein thrombosis
c) Buerger's disease
d) venous thrombosis
d) venous thrombosis

REMEMBER . . .

Virchow's triad:

* venous stasis
* damage of endothelium
* hypercoaguability of blood
In association with venous thrombosis when venous valves are dydfunctional or muscles of the extremities are inactive:

a) venous stasis
b) endothelial damage
c) hypercoaguability
a) venous stasis

occurs more frequently in obesity, congestive heart failure, long trips, prolonged immobility, spinal cord injuries, fractured hips, pregnant women, postpartum, atrial fibrillation, corticosteroids, quinine
In association with venous thrombosis when trauma or external pressure & anytime a venipuncture is performed:

a) venous stasis
b) endothelial damage
c) hypercoaguability
b) endothelial damage

increased edothelial damage (inner lining of the vein) occurs when patients on IV therapy are receiving caustic substances such as high dose antibiotics, potassium, chemo, hypertonic solutions such as parenteral nutrition or contrast media

the prolonged presence of IV cath (48hrs +) in same site, contaminated IV equip., fracture causing damage to vessels, diabetis melitus, blood pooling, burns unusual physical exertion resulting in muscle strain
In association with venous thrombosis, this occurs in many hematologic disorders such as polycythemia, severe anemia, various malignancies & numerous other disorders:

a) venous stasis
b) endothelial damage
c) hypercoaguability
c) hypercoaguability

A patient w/sepsis is predisposed to hypercoaguability

Women taking estrogen-based oral contraceptives or post menopausal using hormone replacements are at increased risk

smoking doubles their risk!

women who smole, use oral contraceptives, over 35, & have family history of venous thrombosis are at EXTREMELY high risk to develop a thrombotic event
A major factor in the detachment of a thrombus from the vein wall that becomes an embolus which will flow through venous circulation to the heart & lodge in the pulmonary circulation thus becomming a pulmonary embolus is:

a) fibrin
b) platelets
c) turbulence
d) occlusion
c) turbulence
Superficial thrombophlebitis presents a palpable, firm cordlike vein that may become tender to touch, reddened & warm & may be accompanied by a mild systemic temperature & with or without edema. Care for this patient would include all of the following except:

a) elevation of the affected extremity
b) warm, moist heat
c) elastic compression stocking if occurance is in a lower extremity
d)analgesics such as aspirin, acetaminophen w.codeine, NSAIDS
c) elastic compression stocking if occurance is in a lower extremity

This should only be done AFTER the condition has resolved !!!
Superficial thrombophlebitis in the lower extremities is more common in:

a) postmenopausal women
b) men 30-45 yrs
c) older patients w. history of venous insufficiency
d) pregnant women
c) older patients w. history of venous insufficiency
and ...
d) pregnant women
A patient w/deep vein throbosis may have no symptoms or have unilateral leg edema, extremity pain, warm skin, erythema & a systemic temp of 100.4F. A positive Homan's sign is:

a) a classic reliable sign
b) a classic but unreliable sign
b) a classic but unreliable sign

A positive Homans sign appears in only 10% of DVT patients & false positives are frequent
With DVT, if the lower extremitie are edematous & cyanotic:

a) the inferior vena cava is involved

b) the superior vena cava is involved
a) the inferior vena cava is involved
With DVT, symptoms of edema with the upper extremities, back, neck & face:

a) the inferior vena cava is involved

b) the superior vena cava is involved
b) the superior vena cava is involved
The most serios complication of DVT is pulmonary embolism, chronic venous insufficiency (CVI)& Phlegmasia cerulea dolens. The patient prescribed bed rest should be instructed to:

a) get out of bed & sit in chair for all 3 meals
b) remain in bed with intemittant compression devices discontinued every 2-4hrs
c) remain in bed but change position, dorsiflex feet, & rotate ankles evry 2-4 hrs
d) continue use of warm, dry compresses
c) remain in bed but change position, dorsiflex feet, & rotate ankles evry 2-4 hrs
The usual TX of DVT is:

1.________
2.________
3.________
1. bed rest
2. elevation of extremity
3. drug therapy
ANticoagulants are routinely used for DVT.

True?
False?
True?

Heparin

Levenox
Normiflo
Fragmin
ArixtrA
Coumadin
Warfarin
Plavix
Anticouagulation therapy does not dissolve clots. The most commonly used anticoagulants are all of te following except:

a) unfractioned heparin
b) low-molecular weight heparins
c) diltiazem derivatives
d) hiruden derivatives
e) coumarin compounds
c) diltiazem derivatives

diltiazem(Cardizem) is a channel blocker that may be prescribed for Raynaud's Disease
Examples of low-molecular weight heparins are all of the following except:

a) lepiruden(Refludan)
b) Enoxaparin (Lovenox)
c) dalteparin (Fragmin)
d) ardeparin ( Normiflo)
a) lepiruden(Refludan)

this is a hirudin derivative
Examples of coumarin compounds are all of the following except:

a) warfarin (Coumadin)
b) heparin
c) acenocoumarol (Sintrom)
d) dicumarol (bishhydroxycoumarin)
c) ardeparin ( Normiflo)
heparin
Tests for blood coagulation are the International normalized ratio (INR), Activated partial thromboplastin time (APTT), & Activated clotting time (ACT). The normal value & the therapeutic value of Warfarin is:

a) 0.75-1.25 / 1-2
b) 0.75-1.25 / 2-3
c) 0.75-1.25 / 3-4
d) 0.75-1.25 / 4-5
normal value/therapeutic value

b) 0.75-1.25 / 2-3
The normal value & the therapeutic value of unfractioned heparin & hirudin derivatives is:

a) 24-36 sec / 16-70 sec
b) 24-36 sec / 26-70 sec
c) 24-36 sec / 36-70 sec
d) 24-36 sec / 46-70 sec
normal value/therapeutic value

d) 24-36 sec / 46-70 sec
The normal value & the therapeutic value of heparin is:

a) 80-135 sec / 1 min
b) 80-135 sec / 2 min
c) 80-135 sec / 3 min
d) 80-135 sec / 4 min
normal value/therapeutic value

c) 80-135 sec / 3 min
Drugs that reduce anticoagulant effects are all of the following except:

a) barbituates
b) carbamazepine (tegretol)
c) chlordiazepoxide (Librium)
d) tetracycline
d) tetracycline

tetracycline increases anticoagulant effects
Drugs that increase anticoagulant effects are all of the following except:

a) cimetidine (Tagamet)
b) fluconazole (Difulcan)
c) cholestyramine (Questran)
d) tetracycline
c) cholestyramine (Questran)

decreases anticoagulant effects
Though most patinets are managed conservatively, small percentages require surgery. Venous thrombectomy & Infferior vena cava filter replacement are recommended for:

a) Buerger's disease
b) pulmonary embolisms
c) superficial thrombophlebitis
d) deep vein thrombosis
d) deep vein thrombosis
Vena cava interruption devices such as Greenfield & Simon-Nitinol filters are inserted percutaneously through superficial femoral or internal jugular veins. This procedure is procedure is indcated with:

a) Buerger's disease
b) pulmonary embolisms
c) superficial thrombophlebitis
d) deep vein thrombosis
d) deep vein thrombosis

cpmplications are rare but include air embolism, improper placement, migration of dilter more distal into venous system & congestion at the filter site.
Acute nursing interventions for patients venous thrombosis is focused on preventing emboli formation & reducing inflammation. Focus should be on all of the following with exception to:

a) observe closely for bleeding
b) monitor urine & stools daily
c) Protect the skin
d) No IM injections'
e) monitor lab values
f) assess mental status changes
all are correct !

it is important to monitor changes in mental status especially in the elderly in the event of cerebral bleeding.
The nurse should closely monitor patients with venous thrombosis and review all of the following except:

a) medications that may interfere w/ anticoagulant therapy
b) use of herbs
c) ambulatory & home care
d) discharge teaching
e) minimizing risk factors
all are necessary
Dilated, tortuous subcutaneous veins frequently found in the saphenous system are termed as:

a) superficial
b) deep
c) varicose
d) innocous
c) varicose
Varicostities (varicose veins) in which the superficial veins are dilated & the valves may or may not be incompetant tends to be familial, bilateral & probably caused by congenital weakness of the veins. This condition is known as:

a) primary varicosities
b) secondary varicose veins
a) primary varicosities
Varicostities (varicose veins) that are a result of previous DVT of the deep femoral veins with subsequent valvular incompetence & may occur in the esophagus, anorectal area (hemmorrhoids),& as abnormal arteriovenous connections, are known as:

a) primary varicosities
b) secondary varicose veins
b) secondary varicose veins
The most common symptom of varicose veins is:

a) coldness
b) numbness
c) cosmetic disfugurement
d) aches & pains
d) aches & pains

an ache or pain after prolonged standingthat is relieved by walking or elevation

pressure, cramplike sensations, swelling, nocturnal leg cramps in the calf are also reported
The most common complication of varicose vains is:

a) Raynuad's
b) deep vein thrombosis
c) superficial thrombophlebitis
d) venous insufficiency
c) superficial thrombophlebitis

rare complications are rupture resulting in ulceration of the skin
Varicose veins are diagnosed primarily by:

a) appearance
b) duplex ultrasound
a) appearance
Though varicose veins is diagnosed by appearance obstruction & reflux in the venous system is detected with considerable accuracy with:

a) Gibbons-Hart meter
b) ultrasound
c) duplex ultrasound
d) Occuturbulance measurements
c) duplex ultrasound
TX for varicose veins is?
compression stockings & exercise
A technique used in TX of unsightly variscosities is?
Sclerotherapy

IV injection of sodium tetradecyl (Sotradecol) to induce inflammation resulting in eventual throbosis of the vein
After sclerotherapy, a cosmetic procedure used for unsightly varicose veins the leg is wrapped in an elastic bandage for:

a) 4-6 hours
b) 12-24 hours
c) 24-72 hours
d) 3-4 days
c) 24-72 hours

local tenderness subsides within 2-3 weeks
SUrgical intervention in the TX of varicose veins involves:

a) sclrotherapy
b) thrombectomy
c) ligation of the entire vein
d) ligation of entire vein & dissection & removal of incompetant tributaries
d) ligation of entire vein & dissection & removal of incompetant tributaries

This procedure is performwed when chronic venous insufficiency cannot be controlled w/conservative therapy or recurrent thrombophlebitis in varicose veins
List 3 procedures used in TX of varicose veins.

1. Scl_ _ _ _ _ _r_ _y

2. Li_ _t_ _n, diss_ _t_ _ _, rem_ _ _ l

3. l_s_r_
1. sclerotherapy
2. ligation, dissection, removal
3. laser
AFter vein ligation surgery the nurse should encourage, check & monitor all of the following except:

a) deep breathing
b) monitor color & movement
c) monitor sensation & temperature
d) monitor for edema & pedal pulses
e) elevate legs at 15-degree angle
f) remove compression stockings at bedtime
f) remove compression stockings at bedtime

compression stockings are applied & removed every 8 hours

encourage deep breathing to promote venous return to the right side of the heart
bruising & discoloration are normal

elevation of legs assists in preventing edema
In long term management of varicose veins, patients should be taught to:

a) put compression stockings on before daily activities begin
b) put compression stocking on as soon as they get out of bed
c) put compresssion stockings on before getting out of bed in the morning
c) put compresssion stockings on before getting out of bed in the morning
Chronic venous insufficiency (CVI) is common among the elderly & often recurs as a result of previous episodes of DVT. A primary concern for these patients is that this condition may lead to:

a) pulmonary embolism
b) thromboangiitis
c) Raynauds
d) venous leg ulcers
d) venous leg ulcers
Chronic venous insufficiency & venous ulceration are all of the following except:

a) life threatening conditions
b) not life threatening
c) painful & debilitating
e) costly chronic conditions
a) life threatening conditions

CVI & venous ulcerations are NOT life threatening
Causes of chronic venous insufficiency are all of the following except:

a) vein incompetence
b) deep vein obstruction
c) congenital venous malformations
d) hypocoaguability
e) arteriovenous fistula
f) calf muscle failure
d) hypocoaguability
The basic dysfunction of chronic venous insufficiency is:

a) deep vein obstruction
b) incompetent valves of the deep veins
c) artiovenous fistulas
d) calf muscle failure
b) incompetent valves of the deep veins

incompetent valves of deep veins result in hydrostatic pressure increasing serous fluid & RBC's leaking into capillaries & venules into tissue causing edema of which enzymes breakdown RBC's causing brownish skin discolorization, fibrous tissue formation around ankles resulting in thick, hardened & contracted skin.
CVI causes a leathery, brownish appearance from:

a) hydrostatic pressure
b) serous fluid & RBC's
c) hemosiderin
d) fibrous tissue
c) hemosiderin

a product of enzymes in the tissue that break down RBC's (caused from edema)
Common complaints of patients with CVI are:

a) eczema
b) pruritis
both eczema & pruritis are common complaints
Venuos ulcers are classically located:

a) below the medial malleolus
b) above the medial malleolus
c) near the lateral malleolus
b) above the medial malleolus

are also found near the lateral malleolus
Complications from venous leg ulcers include all of the following except:

a) wound infection
b) cellulitis
c) Raynaud's
d) amputations
d) pain
c) Raynaud's
Which of the following is considered essential to the management of CVI:

a) compression
b) moist environment dressings
c) antibiotic therapy
d) nutritional status & intake
COMPRESSION !!!

all of the others are additional TX for CVI

Routine antibiotic therapy is not typically indicated unless infection is present & indicated by a culture.

Infection is usually TX w/ sharp debridement, wound exision, systemic antibiotics
The mainstay of wound care in patients with venous leg ulcers is:

a) compression
b) moist environment dressings
c) antibiotic therapy
d) nutritional status & intake
b) moist environment dressings

transparent film dressings
hydrocolloids
hydrogels
foams
calcium alginates
impregnated gauze
gauze moistened w/saline
combination dressings
Nutritional status & intake should be evaluated & a balanced diet with adequate protein, calories, & micronutrients are essential for healing& nutrients that are most important are:

a) protein
b) vit A
c) vit C
d) zinc
protein A, C, & Zinc are all essential
If a venous leg ulcer fails to respond to conservative therapy:

a) radiant heat bandage (Warm-Up-Active Wound Therapy)
b) split thickness skin graft
c) cultured epithelial autografts
d) allografts
e) bioengineered skin (Apeligraf)
all are applicable
Nursing management of Venous leg ulcers should focus on:

a) teaching self care measures because the incidence of recurrence is high
b) Patient & family teaching of avoiding trauma to the limbs
c) proper skin care
d) application of compression stockings
e) appropriate activity & limb positioning
All !
The blockage of pulmonary arteries by thrombus, fat, air emboli, & tumor tissue is identified as:

a) deep vein thrombosis
b) Buerger's Disease
c) Congestive heart failure
d) pulmonary embolism
d) pulmonary embolism
The most common pulmonary complication in hospitalized patients is:

a) deep vein thrombosis
b) Buerger's Disease
c) Congestive heart failure
d) pulmonary embolism
d) pulmonary embolism
The most common signs of pulmonary embolism are all of the following except:

a) sudden feeling of well being
b) anxiety
c) sudden dyspnea
d) sudden tachypnea
e) sudden tachycardi
a) sudden feeling of well being

OTHER SIGNS:

cough
pleuritic chest pain
hemoptysis
crackles
fever
accentuation of pulmonic heart sound
sudden change in mental status as a result of hypoxemia