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MSN Exam for Abdominal Aortic Aneurysm (PM)
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Question 1
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:
A
CHF
B
Buerger’s disease
C
Aneurysm
D
Secondary hypertension
Question 1 Explanation:
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.
Question 2
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 :
A
putting several warm blankets on her
B
assessing her VS especially her RR
C
placing her in a trendeleburg position
D
monitoring her hourly urine output
Question 2 Explanation:
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.
Question 3
Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?
A
HPN
B
PVD
C
Syphilis
D
DM
Question 3 Explanation:
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.
Question 4
Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm?
A
Severe lower back pain, decreased blood pressure, decreased RBC count, decreased RBC count, decreased WBC count.
B
Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count.
Lower back pain, increased blood pressure, decreased re blood cell (RBC) count, increased white blood (WBC) count.
Question 4 Explanation:
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.
Question 5
Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?
A
Cardiac arrythmias
B
HPN
C
Aneurysm rupture
D
Diminished pedal pulses
Question 5 Explanation:
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.
Question 6
With which of the following disorders is jugular vein distention most prominent?
A
Myocardial infarction
B
Pneumothorax
C
Abdominal aortic aneurysm
D
Heart failure
Question 6 Explanation:
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.
Question 7
Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
A
Intermittent lower back pain, decreased BP, decreased RBC, increased WBC
B
Severe lower back pain, decreased BP, decreased RBC, increased WBC
C
Lower back pain, increased BP, decreased RBC, increased WBC
D
Severe lower back pain, decreased BP, decreased RBC, decreased WBC
Question 7 Explanation:
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.
Question 8
When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?
A
Directly over the umbilicus
B
Right upper quadrant
C
Midline lower abdomen to the right of the midline
D
Middle lower abdomen to the left of the midline
Question 8 Explanation:
The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.
Question 9
A pulsating abdominal mass usually indicates which of the following conditions?
A
Abdominal aortic aneurysm
B
Gastritis
C
Gastric distention
D
Enlarged spleen
Question 9 Explanation:
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.
Question 10
What is the definitive test used to diagnose an abdominal aortic aneurysm?
A
Arteriogram
B
Ultrasound
C
Abdominal X-ray
D
CT scan
Question 10 Explanation:
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.
Question 11
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?
A
The patient will be discharged home to follow-up with his cardiologist in 24 hours.
B
The patient will be admitted to the medicine unit for observation and medication.
C
The patient will be admitted to the surgical unit and resection will be scheduled.
D
The patient will be admitted to the day surgery unit for sclerotherapy.
Question 11 Explanation:
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.
Question 12
Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?
A
Dullness
B
Crackles
C
Bruit
D
Friction rubs
Question 12 Explanation:
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.
Question 13
Which of the following blood vessel layers may be damaged in a client with an aneurysm?
A
Interna
B
Media
C
Interna and Media
D
Externa
Question 13 Explanation:
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.
Question 14
What is the most common cause of abdominal aortic aneurysm?
A
Syphilis
B
DM
C
Atherosclerosis
D
HPN
Question 14 Explanation:
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.
Question 15
Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
A
Angina
B
Lower back pain
C
Absent pedal pulses
D
Abdominal pain
Question 15 Explanation:
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.
Question 16
In which of the following areas is an abdominal aortic aneurysm most commonly located?
A
Adjacent to the aortic branch
B
Distal to the iliac arteries
C
Distal to the renal arteries
D
Proximal to the renal arteries
Question 16 Explanation:
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.
Question 17
A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aortic aneurysm is:
A
Pulsations in the periumbilical area
B
Loss of sensation in the lower extremities
C
Back pain that lessens when standing
D
Decreased urinary output
Question 17 Explanation:
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.
Question 18
Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
A
Chest pain.
B
Lower back pain.
C
Absent pedal pulses.
D
Abdominal pain.
Question 18 Explanation:
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.
Question 19
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?
A
Medicine men are not approved by the hospital as legitimate health care providers.
B
Provision of holistic care requires that the client’s belief system is honored.
C
The principle of justice prohibits giving one client a privilege that other clients are not permitted.
D
Faith healers do not meet the standards for clergy exemption from visitation rules.
Question 19 Explanation:
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. 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. 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. 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.
Question 20
Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?
A
Retroperitoneal rupture at the repair site
B
Rapid expansion of the aneurysm
C
Stage 1 pressure ulcer
D
Hernia
Question 20 Explanation:
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.
Question 21
What is the most common symptom in a client with abdominal aortic aneurysm?
A
Headache
B
Upper back pain
C
Diaphoresis
D
Abdominal pain
Question 21 Explanation:
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.
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MSN Exam for Abdominal Aortic Aneurysm (EM)
Choose the letter of the correct answer. You got 21 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Abdominal Aortic Aneurysm (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
A
Angina
B
Abdominal pain
C
Lower back pain
D
Absent pedal pulses
Question 1 Explanation:
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.
Question 2
A pulsating abdominal mass usually indicates which of the following conditions?
A
Gastritis
B
Gastric distention
C
Abdominal aortic aneurysm
D
Enlarged spleen
Question 2 Explanation:
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.
Question 3
Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?
A
Diminished pedal pulses
B
HPN
C
Aneurysm rupture
D
Cardiac arrythmias
Question 3 Explanation:
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.
Question 4
Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
A
Abdominal pain.
B
Absent pedal pulses.
C
Chest pain.
D
Lower back pain.
Question 4 Explanation:
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.
Question 5
In which of the following areas is an abdominal aortic aneurysm most commonly located?
A
Proximal to the renal arteries
B
Adjacent to the aortic branch
C
Distal to the iliac arteries
D
Distal to the renal arteries
Question 5 Explanation:
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.
Question 6
With which of the following disorders is jugular vein distention most prominent?
A
Pneumothorax
B
Abdominal aortic aneurysm
C
Myocardial infarction
D
Heart failure
Question 6 Explanation:
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.
Question 7
Which of the following blood vessel layers may be damaged in a client with an aneurysm?
A
Interna
B
Media
C
Externa
D
Interna and Media
Question 7 Explanation:
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.
Question 8
When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?
A
Middle lower abdomen to the left of the midline
B
Right upper quadrant
C
Midline lower abdomen to the right of the midline
D
Directly over the umbilicus
Question 8 Explanation:
The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.
Question 9
A client is admitted with suspected abdominal aortic aneurysm (AAA). A common complaint of the client with an abdominal aortic aneurysm is:
A
Pulsations in the periumbilical area
B
Decreased urinary output
C
Back pain that lessens when standing
D
Loss of sensation in the lower extremities
Question 9 Explanation:
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.
Question 10
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?
A
Medicine men are not approved by the hospital as legitimate health care providers.
B
The principle of justice prohibits giving one client a privilege that other clients are not permitted.
C
Faith healers do not meet the standards for clergy exemption from visitation rules.
D
Provision of holistic care requires that the client’s belief system is honored.
Question 10 Explanation:
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. 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. 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. 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.
Question 11
What is the definitive test used to diagnose an abdominal aortic aneurysm?
A
Ultrasound
B
Arteriogram
C
CT scan
D
Abdominal X-ray
Question 11 Explanation:
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.
Question 12
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:
A
CHF
B
Aneurysm
C
Secondary hypertension
D
Buerger’s disease
Question 12 Explanation:
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.
Question 13
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 :
A
placing her in a trendeleburg position
B
monitoring her hourly urine output
C
assessing her VS especially her RR
D
putting several warm blankets on her
Question 13 Explanation:
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.
Question 14
What is the most common symptom in a client with abdominal aortic aneurysm?
A
Abdominal pain
B
Headache
C
Diaphoresis
D
Upper back pain
Question 14 Explanation:
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.
Question 15
Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?
A
Rapid expansion of the aneurysm
B
Stage 1 pressure ulcer
C
Hernia
D
Retroperitoneal rupture at the repair site
Question 15 Explanation:
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.
Question 16
Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?
A
DM
B
PVD
C
Syphilis
D
HPN
Question 16 Explanation:
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.
Question 17
Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?
A
Bruit
B
Dullness
C
Friction rubs
D
Crackles
Question 17 Explanation:
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.
Question 18
Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
A
Severe lower back pain, decreased BP, decreased RBC, decreased WBC
B
Intermittent lower back pain, decreased BP, decreased RBC, increased WBC
C
Lower back pain, increased BP, decreased RBC, increased WBC
D
Severe lower back pain, decreased BP, decreased RBC, increased WBC
Question 18 Explanation:
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.
Question 19
What is the most common cause of abdominal aortic aneurysm?
A
HPN
B
Syphilis
C
DM
D
Atherosclerosis
Question 19 Explanation:
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.
Question 20
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?
A
The patient will be admitted to the medicine unit for observation and medication.
B
The patient will be admitted to the surgical unit and resection will be scheduled.
C
The patient will be admitted to the day surgery unit for sclerotherapy.
D
The patient will be discharged home to follow-up with his cardiologist in 24 hours.
Question 20 Explanation:
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.
Question 21
Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm?
Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count.
C
Lower back pain, increased blood pressure, decreased re blood cell (RBC) count, increased white blood (WBC) count.
D
Severe lower back pain, decreased blood pressure, decreased RBC count, decreased RBC count, decreased WBC count.
Question 21 Explanation:
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.
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1) Which of the following signs and symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
Abdominal pain.
Absent pedal pulses.
Chest pain.
Lower back pain.
2) With which of the following disorders is jugular vein distention most prominent?
Abdominal aortic aneurysm
Heart failure
Myocardial infarction
Pneumothorax
3) What is the most common cause of abdominal aortic aneurysm?
Atherosclerosis
DM
HPN
Syphilis
4) In which of the following areas is an abdominal aortic aneurysm most commonly located?
Distal to the iliac arteries
Distal to the renal arteries
Adjacent to the aortic branch
Proximal to the renal arteries
5) A pulsating abdominal mass usually indicates which of the following conditions?
Abdominal aortic aneurysm
Enlarged spleen
Gastic distention
Gastritis
6) What is the most common symptom in a client with abdominal aortic aneurysm?
Abdominal pain
Diaphoresis
Headache
Upper back pain
7) Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
Abdominal pain
Absent pedal pulses
Angina
Lower back pain
8) What is the definitive test used to diagnose an abdominal aortic aneurysm?
Abdominal X-ray
Arteriogram
CT scan
Ultrasound
9) Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?
HPN
Aneurysm rupture
Cardiac arrythmias
Diminished pedal pulses
10) Which of the following blood vessel layers may be damaged in a client with an aneurysm?
Externa
Interna
Media
Interna and Media
11) When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?
Right upper quadrant
Directly over the umbilicus
Middle lower abdomen to the left of the midline
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?
DM
HPN
PVD
Syphilis
13) Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?
Bruit
Crackles
Dullness
Friction rubs
14) Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
Lower back pain, increased BP, decreased RBC, increased WBC
Severe lower back pain, decreased BP, decreased RBC, increased WBC
Severe lower back pain, decreased BP, decreased RBC, decreased WBC
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?
Hernia
Stage 1 pressure ulcer
Retroperitoneal rupture at the repair site
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:
Loss of sensation in the lower extremities
Back pain that lessens when standing
Decreased urinary output
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 :
placing her in a trendeleburg position
putting several warm blankets on her
monitoring her hourly urine output
assessing her VS especially her RR
18) Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm?
Lower back pain, increased blood pressure, decreased re blood cell (RBC) count, increased white blood (WBC) count.
Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count.
Severe lower back pain, decreased blood pressure, decreased RBC count, decreased RBC count, decreased 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?
The patient will be admitted to the medicine unit for observation and medication.
The patient will be admitted to the day surgery unit for sclerotherapy.
The patient will be admitted to the surgical unit and resection will be scheduled.
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:
Buerger’s disease
CHF
Secondary hypertension
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?
The principle of justice prohibits giving one client a privilege that other clients are not permitted.
Faith healers do not meet the standards for clergy exemption from visitation rules.
Medicine men are not approved by the hospital as legitimate health care providers.
Provision of holistic care requires that the client’s belief system is honored.
Answers and Rationales
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.