The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm?

Hematemesis

Rectal bleeding

Hypertensive crisis

Severe pain

Answer and Explanation

The Correct Answer is D

A. Hematemesis: Vomiting blood suggests upper gastrointestinal bleeding but is not typically associated with abdominal aortic aneurysm dissection. It is more indicative of conditions like esophageal varices or gastric ulcers.
B. Rectal bleeding: Rectal bleeding points to lower GI tract issues and is not a sign of an aortic dissection. AAA dissection causes internal vascular compromise, not bleeding through the rectum.
C. Hypertensive crisis: Although hypertension may contribute to aneurysm formation or rupture, a dissection often leads to hypotension due to blood loss or shock. It is not the most definitive sign of a dissection.
D. Severe pain: When an AAA dissects, the layers of the aorta tear, causing blood to leak out of the main channel. This process is intensely painful, often described as a sudden, severe, tearing, or ripping pain. Sudden, intense pain in the abdomen, chest, or back is a hallmark sign of an AAA dissection.

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Correct Answer is D

Explanation

A. Bladder trauma: Bladder injuries are more commonly associated with lower abdominal or pelvic trauma, especially from a direct blow or pelvic fracture, not chest compression.
B. A pleural effusion: Pleural effusion refers to fluid accumulation in the pleural space, usually from infection, malignancy, or inflammation. It does not occur suddenly from blunt chest trauma.
C. Fractured pelvis: A pelvic fracture is typically caused by impact to the lower body or hip area, not by forceful chest compression against a steering wheel.
D. Cardiac tamponade: Blunt chest trauma can lead to bleeding into the pericardial sac, causing cardiac tamponade. This is a life-threatening condition where fluid compresses the heart, impairing its ability to pump effectively. It is a likely concern in cases of severe chest impact.

A. Thiazide diuretic B. ACE inhibitors C. Calcium channel blocker D. Beta-blocker

Correct Answer is A

Explanation

A. Thiazide diuretic: Thiazide diuretics are often the first-line pharmacologic treatment for stage 1 hypertension when lifestyle changes alone are ineffective. They reduce blood volume and peripheral resistance, effectively lowering blood pressure.
B. ACE inhibitors: ACE inhibitors are commonly used, especially in clients with diabetes or heart failure, but they are generally considered after thiazide diuretics unless there is a compelling comorbidity.
C. Calcium channel blocker: These are also used to manage hypertension, particularly in older adults or those with certain cardiovascular risks, but not typically as the first step without other indications.
D. Beta-blocker: Beta-blockers are not usually first-line for uncomplicated hypertension. They are more appropriate when there are concurrent conditions like heart failure, arrhythmias, or post-MI care.

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The nurse is caring for a client with abdominal aortic aneurysm (AAA). Which assessment finding is most likely to indicate a dissection of the aneurysm?

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