Chapter 99: Abdominal Aortic Aneurysm Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action?

a. Immediate referral to a thoracic surgeon b. Ordering computerized tomography (CT) angiography c. Scheduling a magnetic resonance imaging (MRI) to evaluate for aortic disease d. Ultrasound of the mass to determine size (US)

ANS: D a. Endovascular stent grafting of the aneurysm b. Immediate open surgical repair of the aneurysm c. No intervention is necessary for this patient d. Serial ultrasonographic surveillance (US) of the aneurysm

This patient has symptoms consistent with an aortic aneurysm. The initial step is to determine the size of the aneurysm; this can be done by US. Immediate referral is not necessary. MRI and CT diagnostic tests are ordered before surgery to evaluate the characteristics of the aneurysm.

2. A 70-year-old patient presents with an aortic aneurysm measuring 5.0 cm. The patient has poorly controlled hypertension, and decompensated heart failure. What is the recommendation for treatment for this patient?

NURSINGTB.COM

ANS: D

This patient’s aneurysm is less than 5.5 cm and repair is not necessary at this time. Serial US surveillance is necessary to continue to evaluate size. Repair is risky in patients with hypertension and heart failure, so avoiding procedures if possible is recommended.