PAD
A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of drugs will the nurse plan to include when teaching about PAD management?
What are Statins?
Research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other drug categories in PAD.
After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which action by the patient best demonstrates that the teaching has been effective?
a. The patient exercises indoors during the winter months.
b. The patient immerses hands in hot water when they turn pale.
c. The patient takes pseudoephedrine (Sudafed) for cold symptoms.
d. The patient avoids taking nonsteroidal antiinflammatory drugs (NSAIDs).
What is answer A?
Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm rather than hot water to warm the hands. Pseudoephedrine is a vasoconstrictor and should be avoided. There is no reason to avoid taking NSAIDs with Raynaud's phenomenon
The health care provider has prescribed bed rest with the feet elevated for a patient admitted to the hospital with venous thromboembolism. Which action by the nurse to elevate the patient's feet is best?
a. The patient is placed in the Trendelenburg position.
b. Two pillows are positioned under the affected leg.
c. The bed is elevated at the knee and pillows are placed under the feet.
d. One pillow is placed under the thighs and two pillows are placed under the lower
legs.
ANS: D
The purpose of elevating the feet is to enhance venous flow from the feet to the right atrium, which is best accomplished by placing two pillows under the feet and one under the thighs. Placing the patient in the Trendelenburg position will lower the head below heart level, which is not indicated for this patient. Placing pillows under the calf or elevating the bed at the knee may cause blood stasis at the calf level.
A 46-yr-old service-counter worker undergoes sclerotherapy for treatment of superficial varicose veins at an outpatient center. Which instructions should the nurse provide to the patient before discharge?
a. Sitting at the work counter, rather than standing, is recommended.
b. Exercise, such as walking or jogging, can cause recurrence of varicosities.
c. Elastic compression stockings should be applied before getting out of bed.
d. Taking an aspirin daily will help prevent clots from forming around venous valves.
ANS: C
Elastic compression stockings are applied with the legs elevated to reduce pressure in the lower legs. Walking is recommended to prevent recurrent varicosities. Sitting and standing are both risk factors for varicose veins and venous insufficiency. An aspirin a day is not adequate to prevent venous thrombosis and would not be recommended for a patient who had just had sclerotherapy.
After receiving change of shift report, which patient admitted to the emergency department should the nurse assess first?
a. A 67-yr-old patient who has a gangrenous left foot ulcer with a weak pedal pulse
b. A 50-yr-old patient who is complaining of sudden sharp and severe upper back
pain
c. A 39-yr-old patient who has right calf tenderness, redness, and swelling after a
plane ride
d. A 58-yr-old patient who is taking anticoagulants for atrial fibrillation and has black
stools
ANS: B
The patient's presentation of sudden sharp and severe upper back pain is consistent with dissecting thoracic aneurysm, which will require the most rapid intervention. The other patients also require rapid intervention but not before the patient with severe pain.
An older patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the health care provider and immediately
What is keep the bed in supine position?
The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the O2 demand of the tissues and minimize ischemic damage until circulation can be restored. Elevating the leg or applying an elastic wrap will further compromise blood flow to the leg. Exercise will increase oxygen demand
A young adult patient tells the health care provider about experiencing cold, numb fingers when running during the winter, and Raynaud's phenomenon is suspected. The nurse will anticipate teaching the patient about tests for
a. hyperglycemia. c. autoimmune disorders.
b. hyperlipidemia. d. coronary artery disease.
ANS: C
Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis. Patients should be screened for autoimmune disorders. Raynaud's phenomenon is not associated with hyperlipidemia, hyperglycemia, or coronary artery disease.
The health care provider prescribes an infusion of heparin and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). The nurse will plan to
a. decrease the infusion when the PTT value is 65 seconds.
b. avoid giving IM medications to prevent localized bleeding.
c. have vitamin K available in case reversal of the heparin is needed.
d. monitor posterior tibial and dorsalis pedis pulses with the Doppler
ANS: B
Intramuscular injections are avoided in patients receiving anticoagulation to prevent hematoma formation and bleeding from the site. A PTT of 65 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.
Which topic should the nurse include in patient teaching for a patient with a venous stasis ulcer on the left lower leg?
a. Need to increase carbohydrate intake
b. Methods of keeping the wound area dry
c. Purpose of prophylactic antibiotic therapy
d. Application of elastic compression stockings
ANS: D
Compression of the leg is essential to healing of venous stasis ulcers. High dietary intake of protein, rather than carbohydrates, is needed. Prophylactic antibiotics are not routinely used for venous ulcers. Moist dressings are used to hasten wound healing
A patient is admitted to the hospital with an abdominal aortic aneurysm. What s/s would suggest that the aneurysm has ruptured?
A. Rapid onset of SOB and hemoptysis
B. Sudden, severe low back pain and bruising along flank
C. Gradually increasing substernal chest pain and diaphoresis
D. Sudden, patchy blue mottling on feet and toes and rest pain
B. Sudden, severe low back pain and bruising along flank
A patient at the clinic says, "I always walk after dinner, but lately my leg cramps and hurts after just a few minutes of starting. The pain goes away after I stop walking, though." The nurse should...
a. look for the presence of tortuous veins bilaterally on the legs.
b. ask about any skin color changes that occur in response to cold.
c. assess for unilateral swelling, redness, and tenderness of either leg.
d. palpate for the presence of dorsalis pedis and posterior tibial pulses.
What is palpate for pedal pulses?
The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin color that occur in response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness indicate venous thromboembolism.
What clinical manifestations can the nurse expect to see in both patients with Burger's disease and Raynaud's phenomenon? (Select all that apply)
A. Intermittent low-grade fevers; B. Sensitivity to cold temperatures; C. Gangrenous ulcers on fingertips; D. Color changes of fingers and toes; E. Episodes of superficial vein thrombosis
ANS: B, C, D
A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is most accurate?
a. "Taking two blood thinners greatly reduces the risk for another clot to form."
b. "Enoxaparin will work right away, but warfarin takes several days to begin preventing clots."
c. "Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from forming."
d. "Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner."
ANS: B
Low molecular weight heparin (LMWH) is used because of the immediate effect on coagulation and discontinued once the international normalized ratio (INR) value indicates that the warfarin has reached a therapeutic level. LMWH has no thrombolytic properties. The use of two anticoagulants is not related to the risk for pulmonary embolism, and two are not necessary to reduce the risk for another VTE. Anticoagulants do not thin the blood.
Which patient statement to the nurse is most consistent with the diagnosis of venous insufficiency?
a. "I can't get my shoes on at the end of the day."
b. "I can't ever seem to get my feet warm enough."
c. "I have burning leg pains after I walk two blocks."
d. "I wake up during the night because my legs hurt."
ANS: A
Because the edema associated with venous insufficiency increases when the patient has been standing, shoes will feel tighter at the end of the day. The other patient statements are characteristic of peripheral artery disease.
What are the priority nursing interventions 8 hours after an abdominal aortic aneurysm repair?
A. Assessing nutritional status and dietary preferences
B. Initiating IV heparin and monitoring anticoagulation
C. Administering IV fluids and watching kidney function
D. Elevating the legs and applying compression stockings
C. Administering IV fluids and watching kidney function
The nurse performing an assessment of a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the right second toe would expect to find
a. dilated superficial veins.
b. swollen, dry, scaly ankles.
c. prolonged capillary refill in all the toes.
d. serosanguineous drainage from the ulcer
What is prolonged capillary refill in all the toes?
Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease
A patient who is 2 days post femoral popliteal bypass graft to the right leg is being cared for on the vascular unit. Which action by a licensed practical/vocational nurse (LPN/LVN) caring for the patient requires the registered nurse (RN) to intervene?
a. The LPN/LVN has the patient to sit in a chair for 2 hours.
b. The LPN/LVN gives the prescribed aspirin after breakfast.
c. The LPN/LVN assists the patient to walk 40 feet in the hallway.
d. The LPN/LVN places the patient in Fowler's position for meals.
ANS: A
The patient should avoid sitting for long periods because of the increased stress on the suture line caused by leg edema and because of the risk for venous thromboembolism (VTE). The other actions by the LPN/LVN are appropriate.
The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) after hospitalization for venous thromboembolism (VTE). The nurse determines that additional teaching is needed when the patient says which of the following?
a. "I should get a Medic Alert device stating that I take warfarin."
b. "I should reduce the amount of green, leafy vegetables that I eat."
c. "I will need routine blood tests to monitor the effects of the warfarin."
d. "I will check with my health care provider before I begin any new drugs."
ANS: B
Patients taking warfarin are taught to follow a consistent diet with regard to foods that are high in vitamin K, such as green, leafy vegetables. The other patient statements are accurate.
The nurse is planning care and teaching for a patient with venous leg ulcers. What is the most important patient action in healing and control of this condition?
A. Following activity guidelines; B. Using moist environment dressings; C. Taking horse chestnut seed extract daily; D. Applying TED hose
ANS: D
What is the first priority of interprofessional care for a patient with a suspected acute aortic dissection?
A. Reduce anxiety; B. Monitor CP; C. Control BP; D. Increase myocardial contractility
C. Control blood pressure
When evaluating the discharge teaching for a patient with chronic peripheral artery disease (PAD), the nurse determines a need for further instruction when the patient says, "I will
a. use a heating pad on my feet at night to increase the circulation."
b. buy some loose clothes that do not bind across my legs or waist."
c. walk to the point of pain, rest, and walk again for at least 30 minutes 3 times a week."
d. change my position every hour and avoid long periods of sitting with my legs crossed."
What is "use a heating pad at night...?"
Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful.
The nurse is developing a discharge teaching plan for a patient diagnosed with thromboangiitis obliterans (Buerger's disease). Which expected outcome has the highest priority for this patient?
a. Cessation of all tobacco use
b. Control of serum lipid levels
c. Maintenance of appropriate weight
d. Demonstration of meticulous foot care
ANS: A
Absolute cessation of nicotine use is needed to reduce the risk for amputation in patients with Buerger's disease. Other therapies have limited success in treatment of this disease.
Which action by a new nurse who is giving fondaparinux (Arixtra) to a patient with a lower leg venous thromboembolism (VTE) indicates that more education about the drug is needed?
a. The nurse avoids rubbing the injection site after giving the drug.
b. The nurse injects the drug into the abdominal subcutaneous tissue.
c. The nurse ejects the air bubble from the syringe before giving the drug.
d. The nurse does not check partial thromboplastin time (PTT) before giving the
drug
ANS: C
The air bubble is not ejected before giving fondaparinux to avoid loss of drug. The other actions by the nurse are appropriate for subcutaneous administration of a low molecular weight heparin (LMWH). LMWHs typically do not require ongoing PTT monitoring and dose adjustment.
A nurse is caring for a client who is postoperative following vein ligation and stripping for varicose veins. Which actions should the nurse take?
A. Position client supine with legs elevated in bed
B. Encourage client to ambulate for 15 min every hour while awake
C. Tell the client to sit with his legs dependent after ambulating
D. Instruct client to wear knee-length socks for 2 weeks after surgery
A. Position the client supine with his legs elevated when in bed.
This promotes venous return by gravity
A nurse is assessing a client who has an AAA. Which of the following findings indicates that it is expanding?
A. Increased BP and decreased PR
B. JVD and peripheral edema
C. Report of sudden, severe back pain
D. Report of retrosternal CP radiating to the left arm
C. Report of sudden, severe back pain