NUR 402 FINAL EXAM NCLEX QUESTIONS AND ANSWERS 2024/2025
ALL ANSWERS 100% CORRECT VERIFIED BEST SOLUTION RATED A+
A female patient with critical limb ischemia has had
peripheral artery bypass surgery to improve her
circulation. What care should the nurse provide on
postoperative day 1?
A) Keep the patient on bed rest.
B) Assist the patient with walking several times.
C) Have the patient sit in the chair several times.
D) Place the patient on her side with knees flexed. -
CORRECT ANSWERS B) Assist the patient with walking
several times.
To avoid blockage of the graft or stent, the patient should
walk several times on postoperative day 1 and subsequent
days. Having the patient's knees flexed for sitting in a chair
or in bed increase the risk of venous thrombosis and may
place stress on the suture lines.
A 40-year-old man tells the nurse he has a diagnosis for
the color and temperature changes of his limbs but can't
,NUR 402 FINAL EXAM NCLEX QUESTIONS AND ANSWERS 2024/2025
ALL ANSWERS 100% CORRECT VERIFIED BEST SOLUTION RATED A+
remember the name of it. He says he must stop smoking
and avoid trauma and exposure of his limbs to cold
temperatures to get better. This description should allow
the nurse to ask the patient if he has which diagnosis?
A) Buerger's disease
B) Venous thrombosis
C) Acute arterial ischemia
D) Raynaud's phenomenon - CORRECT ANSWERS A)
Buerger's disease
Buerger's disease is a nonatherosclerotic, segmental,
recurrent inflammatory disorder of small and medium-
sized veins and arteries of upper and lower extremities
leading to color and temperature changes of the limbs,
intermittent claudication, rest pain, and ischemic
ulcerations. It primarily occurs in men younger than 45
years old with a long history of tobacco and/or marijuana
use. Buerger's disease treatment includes smoking
cessation, trauma and cold temperature avoidance, and a
walking program. Venous thrombosis is the formation of a
,NUR 402 FINAL EXAM NCLEX QUESTIONS AND ANSWERS 2024/2025
ALL ANSWERS 100% CORRECT VERIFIED BEST SOLUTION RATED A+
thrombus in association with inflammation of the vein.
Acute arterial ischemia is a sudden interruption in arterial
blood flow to a tissue caused by embolism, thrombosis, or
trauma. Raynaud's phenomenon is characterized by
vasospasm-induced color changes of the fingers, toes, ears,
and nose.
A male patient was admitted for a possible ruptured aortic
aneurysm, but had no back pain. Ten minutes later his
assessment includes the following: sinus tachycardia at
138, BP palpable at 65 mm Hg, increasing waist
circumference, and no urine output. How should the nurse
interpret this assessment about the patient's aneurysm?
A) Tamponade will soon occur.
B) The renal arteries are involved.
C) Perfusion to the legs is impaired.
D) He is bleeding into the abdomen. - CORRECT ANSWERS
D) He is bleeding into the abdomen.
, NUR 402 FINAL EXAM NCLEX QUESTIONS AND ANSWERS 2024/2025
ALL ANSWERS 100% CORRECT VERIFIED BEST SOLUTION RATED A+
The lack of back pain indicates the patient is most likely
exsanguinating into the abdominal space, and the bleeding
is likely to continue without surgical repair. A blockade of
the blood flow will not occur in the abdominal space as it
would in the retroperitoneal space where surrounding
anatomic structures may control the bleeding. The lack of
urine output does not indicate renal artery involvement,
but that the bleeding is occurring above the renal arteries,
which decreases the blood flow to the kidneys. There is no
assessment data indicating decreased perfusion to the
legs.
The patient had aortic aneurysm repair. What priority
nursing action will the nurse use to maintain graft
patency?
A) Assess output for renal dysfunction.
B) Use IV fluids to maintain adequate BP.
C) Use oral antihypertensives to maintain cardiac output.
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