MSN Exam for Abdominal Aortic Aneurysm

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1) Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?

1. Abdominal pain.
2. Absent pedal pulses.
3. Chest pain.
4. Lower back pain.

2) With which of the following disorders is jugular vein distention most prominent?

1. Abdominal aortic aneurysm
2. Heart failure
3. Myocardial infarction
4. Pneumothorax

3) What is the most common cause of abdominal aortic aneurysm?

1. Atherosclerosis
2. DM
3. HPN
4. Syphilis

4) In which of the following areas is an abdominal aortic aneurysm most commonly located?

1. Distal to the iliac arteries
2. Distal to the renal arteries
3. Adjacent to the aortic branch
4. Proximal to the renal arteries

5) A pulsating abdominal mass usually indicates which of the following conditions?

1. Abdominal aortic aneurysm
2. Enlarged spleen
3. Gastic distention
4. Gastritis

6) What is the most common symptom in a client with abdominal aortic aneurysm?

1. Abdominal pain
2. Diaphoresis
3. Headache
4. Upper back pain

7) Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?

1. Abdominal pain
2. Absent pedal pulses
3. Angina
4. Lower back pain

8) What is the definitive test used to diagnose an abdominal aortic aneurysm?

1. Abdominal X-ray
2. Arteriogram
3. CT scan
4. Ultrasound

9) Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?

1. HPN
2. Aneurysm rupture
3. Cardiac arrythmias
4. Diminished pedal pulses

10) Which of the following blood vessel layers may be damaged in a client with an aneurysm?

1. Externa
2. Interna
3. Media
4. Interna and Media

11) When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?

1. Right upper quadrant
2. Directly over the umbilicus
3. Middle lower abdomen to the left of the midline
4. Midline lower abdomen to the right of the midline

12) Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?

1. DM
2. HPN
3. PVD
4. Syphilis

13) Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?

1. Bruit
2. Crackles
3. Dullness
4. Friction rubs

14) Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?

1. Lower back pain, increased BP, decreased RBC, increased WBC
2. Severe lower back pain, decreased BP, decreased RBC, increased WBC
3. Severe lower back pain, decreased BP, decreased RBC, decreased WBC
4. Intermittent lower back pain, decreased BP, decreased RBC, increased WBC

15) Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?

1. Hernia
2. Stage 1 pressure ulcer
3. Retroperitoneal rupture at the repair site
4. Rapid expansion of the aneurysm

16) A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aortic aneurysm is:

1. Loss of sensation in the lower extremities
2. Back pain that lessens when standing
3. Decreased urinary output
4. Pulsations in the periumbilical area

17) Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurse’s priority should be :

1. placing her in a trendeleburg position
2. putting several warm blankets on her
3. monitoring her hourly urine output
4. assessing her VS especially her RR

18) Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm?

1. Lower back pain, increased blood pressure, decreased re blood cell (RBC) count, increased white blood (WBC) count.
2. Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count.
3. Severe lower back pain, decreased blood pressure, decreased RBC count, decreased RBC count, decreased WBC count.
4. Intermitted lower back pain, decreased blood pressure, decreased RBC count, increased WBC count.

19) A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?

1. The patient will be admitted to the medicine unit for observation and medication.
2. The patient will be admitted to the day surgery unit for sclerotherapy.
3. The patient will be admitted to the surgical unit and resection will be scheduled.
4. The patient will be discharged home to follow-up with his cardiologist in 24 hours.

20) A 76 year old man enters the ER with complaints of back pain and feeling fatigued. Upon examination, his blood pressure is 190/100, pulse is 118, and hematocrit and hemoglobin are both low. The nurse palpates the abdomen which is soft, non-tender and auscultates an abdominal pulse. The most likely diagnosis is:

1. Buerger’s disease
2. CHF
3. Secondary hypertension
4. Aneurysm

21) An adult client has continued slow bleeding from the graft after repair of an abdominal aortic aneurysm. Because of the client’s unstable condition, he is in the intensive care unit where visitors are limited to the family. The client insists on having a visit from a medicine man whom the family visits regularly. How should the nurse interpret this request?

1. The principle of justice prohibits giving one client a privilege that other clients are not permitted.
2. Faith healers do not meet the standards for clergy exemption from visitation rules.
3. Medicine men are not approved by the hospital as legitimate health care providers.
4. Provision of holistic care requires that the client’s belief system is honored.

Answers and Rationales

1. D. Lower back pain. Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdomen, and the pain is referred to the lower back. Abdominal pain is the most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Chest pain usually is associated with coronary artery or pulmonary disease.
2. B. Heart failure. Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. Jugular vein distention isn’t a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn’t cause jugular vein distention.
3. A. Atherosclerosis . Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and weaken it, causing an aneurysm. Although the other conditions are related to the development of an aneurysm, none is a direct cause.
4. B. Distal to the renal arteries. The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn’t surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta.
5. A. Abdominal aortic aneurysm. The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastic distention cause pulsation.
6. A. Abdominal pain. Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. Lower back pain, not upper, is a common symptom, usually signifying expansion and impending rupture of the aneurysm. Headache and diaphoresis aren’t associated with abdominal aortic aneurysm.
7. D. Lower back pain . Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Angina is associated with atherosclerosis of the coronary arteries.
8. B. Arteriogram . An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities. An abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound don’t give a direct view of the vessels and don’t yield as accurate a diagnosis as the arteriogram.
9. B. Aneurysm rupture. Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm but isn’t life threatening. Cardiac arrhythmias aren’t directly linked to an aneurysm.
10. C. Media . The factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less elastic fibers, so it’s more capable of vasoconstriction and vasodilation. The interna and externa are generally no damaged in an aneurysm.
11. C. Middle lower abdomen to the left of the midline . The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.
12. B. HPN. Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isn’t as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm. Diabetes mellitus doesn’t have direct link to aneurysm.
13. A. Bruit. A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. Crackles are indicative of fluid in the lungs. Dullness is heard over solid organs, such as the liver. Friction rubs indicate inflammation of the peritoneal surface.
14. B. Severe lower back pain, decreased BP, decreased RBC, increased WBC. Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When rupture occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count is decreased – not increase. The WBC count increases as cells migrate to the site of injury.
15. C. Retroperitoneal rupture at the repair site. Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused by leakage at the repair site. A hernia doesn’t cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, a hematoma won’t form.
16. D. Pulsations in the periumbilical area. The client with an abdominal aortic aneurysm frequently complains of pulsations or “feeling my heart beat” in the abdomen. Answers A and C are incorrect because they occur with rupture of the aneurysm. Answer B is incorrect because back pain is not affected by changes in position.
17. D. assessing her VS especially her RR . Shock is characterized by reduced tissue and organ perfusion and eventual organ dysfunction and failure. Checking on the VS especially the RR, which detects need for oxygenation, is a priority to help detect its progress and provide for prompt management before the occurrence of complications.
18. B. Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count. Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When ruptured occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count is decreased – not increased. The WBC count increases as cell migrate to the site of injury.
19. C. The patient will be admitted to the surgical unit and resection will be scheduled. A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and should be resected as soon as possible. No other appropriate treatment options currently exist.
20. D. Aneurysm. The symptoms exhibited by the client are typical of an abdominal aortic aneurysm. The most significant sign is the audible pulse in the abdominal area. If hemorrhage were present, the abdomen would be tender and firm.
21. D. Provision of holistic care requires that the client’s belief system is honored. The client’s spiritual needs must be met within the framework of his personal belief systems, even if those beliefs differ from those of the nursing staff.