PAD Nursing Care
Which nursing instruction is most important for a patient with PAD to prevent tissue injury?
A. Wear compression stockings daily
B. Apply heating pads to cold feet
C. Elevate legs on pillows during sleep
D. Inspect feet daily and avoid walking barefoot
D. Inspect feet daily and avoid walking barefoot
*Why not compression or heat? they can worsen arterial ischemia
Which nursing intervention is most effective in reducing the risk of progression of an aortic aneurysm?
A. Strict blood pressure control and smoking cessation
B. Daily aspirin therapy
C. Increasing physical activity intensity
D. High-protein diet
A. Strict blood pressure control and smoking cessation
*most modifiable risk factors
A patient with paroxysmal supraventricular tachycardia (PSVT) does not respond to vagal maneuvers. Which medication should the nurse expect to administer next?
A. Adenosine
B. Lidocaine
C. Amiodarone
D. Digoxin
A. Adenosine
*drug of choice for PSVT when vagal maneuvers fail
Which complication is the greatest concern for a patient with long-standing atrial fibrillation?
A. Acute myocardial ischemia
B. Development of ventricular tachycardia
C. Complete heart block
D. Thrombus formation leading to stroke
D. Thrombus formation leading to stroke
A hospitalized patient with a known lower-extremity DVT suddenly reports sharp chest pain and shortness of breath. Which nursing action is the priority?
A. Elevate the legs and apply compression stockings
B. Administer prescribed PRN opioid for pain
C. Assess oxygen saturation and apply supplemental oxygen
D. Encourage the patient to ambulate
C. Assess oxygen saturation and apply supplemental oxygen
*What is suspected?
A patient with PAD reports worsening calf pain when walking that improves with rest. Which nursing intervention is most appropriate to improve this patient’s long-term outcomes?
A. Encourage rest and avoidance of leg pain
B. Promote supervised walking until pain occurs, followed by rest
C. Apply heating pads to the lower extremities to improve circulation
D. Elevate the legs above the level of the heart when resting
B. Promote supervised walking until pain occurs, followed by rest
*graded exercise improves collateral circulation
A patient with a known abdominal aortic aneurysm suddenly reports severe abdominal and back pain, dizziness, and hypotension. What is the priority nursing action?
A. Place the patient supine and elevate legs
B. Administer prescribed antihypertensives
C. Notify the provider and activate emergency response
D. Obtain a detailed pain assessment
C. Notify the provider and activate emergency response
*why? sudden rupture, medical emergency
A patient on telemetry develops ventricular tachycardia at a rate of 180 bpm. The patient is alert, blood pressure is 118/74, and a carotid pulse is present. What is the priority nursing action?
A. Initiate CPR
B. Prepare for immediate defibrillation
C. Administer prescribed antidysrhythmic medication
D. Apply transcutaneous pacing pads
C. Administer prescribed antidysrhythmic medication
*pt is has a pulse and is stable
A patient with atrial fibrillation and rapid ventricular rate develops hypotension and altered mental status. What is the most appropriate nursing action?
A. Administer oral beta blockers
B. Prepare for synchronized cardioversion
C. Initiate anticoagulation therapy
D. Encourage deep breathing and rest
B. Prepare for synchronized cardioversion
*Unstable Afib (hypotension, AMS) requires immediate cardioversion.
A patient receiving enoxaparin (Lovenox) for VTE develops bleeding gums and hematuria. Which nursing action is most appropriate?
A. Increase ambulation frequency
B. Administer vitamin K
C. Apply compression stockings
D. Hold the medication and notify the provider
D. Hold the medication and notify the provider
A patient with peripheral artery disease (PAD) is prescribed aspirin 81 mg daily. What is the primary purpose of this medication in the management of PAD?
A. To reduce platelet aggregation and lower the risk of cardiovascular events
B. To dilate peripheral arteries and immediately relieve claudication pain
C. To directly dissolve existing atherosclerotic plaques
D. To increase blood viscosity and improve oxygen delivery
A. To reduce platelet aggregation and lower the risk of cardiovascular events
A patient is admitted to the ICU following aortic aneurysm repair. Which assessment finding requires immediate follow-up?
A. Mild incisional discomfort
B. Anxiety related to surgery
C. Slightly elevated blood pressure
D. Decreased urine output
D. Decreased urine output
*why?? decreased renal perfusion or graft complication
Telemetry shows a progressive lengthening of the PR interval followed by a dropped QRS complex. How should the nurse interpret this rhythm?
A. Second-degree AV block type I (Wenckebach)
B. Second-degree AV block type II
C. First-degree AV block
D. Third-degree AV block
A. Second-degree AV block type I (Wenckebach)
A patient has frequent premature ventricular contractions (PVCs) on telemetry. Which assessment finding is most concerning?
A. PVCs occurring after caffeine intake
B. Isolated PVCs during sleep
C. Occasional PVCs in an otherwise healthy adult
D. PVCs in a patient with heart failure and low EF
D. PVCs in a patient with heart failure and low EF
*Remember: Structural heart disease + PVCs ↑ risk of VT/VF
Which finding is most concerning for a massive pulmonary embolism?
A. Low-grade fever and cough
B. Wheezing and crackles
C. Sudden hypotension and altered mental status
D. Gradual onset dyspnea
C. Sudden hypotension and altered mental status
A patient with known PAD suddenly develops severe lower extremity pain, pallor, pulselessness, and paresthesia. What is the priority nursing action?
A. Elevate the affected extremity
B. Apply warm blankets to the limb
C. Notify the healthcare provider immediately
D. Administer prescribed analgesics
C. Notify the healthcare provider immediately
*why?
Which nursing intervention would be contraindicated in a patient with suspected aortic dissection?
A. Administering IV opioids for pain
B. Continuous arterial blood pressure monitoring
C. Rapid lowering of BP without titration
D. Placing the patient in semi-Fowler’s position
C. Rapid lowering of BP without titration
*why not rapid BP reduction?
A patient with ventricular fibrillation is receiving CPR while the crash cart is brought to the bedside. Which medication would the nurse expect to administer after defibrillation attempts?
A. Adenosine
B. Atropine
C. Amiodarone
D. Diltiazem
C. Amiodarone
*ACLS
A patient develops sinus tachycardia with a heart rate of 130 bpm following surgery. Which nursing intervention is most appropriate?
A. Administer adenosine
B. Treat the underlying cause (pain, hypovolemia, hypoxia)
C. Perform synchronized cardioversion
D. Initiate anticoagulation therapy
B. Treat the underlying cause (pain, hypovolemia, hypoxia)
*Remember that ST is usually a physiologic response, not a primary rhythm problem
A patient receiving warfarin (Coumadin) for VTE asks which lab value will be monitored to ensure the medication is effective. Which is the best response?
A. Activated partial thromboplastin time (aPTT)
B. Platelet count
C. Anti-factor Xa level
D. International Normalized Ratio (INR)
D. International Normalized Ratio (INR)
A patient with advanced PAD develops nonhealing ulcers and rest pain. This presentation most strongly suggests which complication?
A. Critical limb ischemia
B. Chronic venous insufficiency
C. Peripheral neuropathy
D. Superficial vein thrombosis
A. Critical limb ischemia
Which medication class is most important initially in the management of acute aortic dissection?
A. Loop diuretics
B. Antiplatelet agents
C. IV beta blockers
D. Thrombolytics
C. IV beta blockers
why?
A patient with sinus bradycardia has a heart rate of 42 bpm and reports dizziness and lightheadedness. Blood pressure is 88/54 mm Hg. Which nursing action is most appropriate?
A. Continue to monitor and reassess in 30 minutes
B. Administer prescribed atropine
C. Prepare for synchronized cardioversion
D. Encourage oral fluid intake
B. Administer prescribed atropine
*symptomatic bradycardia
A patient on telemetry suddenly loses consciousness. The monitor shows a chaotic rhythm with no identifiable QRS complexes. What is the priority nursing action?
A. Apply transcutaneous pacing pads
B. Administer epinephrine
C. Perform synchronized cardioversion
D. Begin CPR and prepare for defibrillation
D. Begin CPR and prepare for defibrillation
*Vfib (a pulseless rhythm) requires immediate CPR and defibrillation
A patient with an acute DVT asks why they are being instructed not to massage the affected leg. What is the best nursing response?
A. “Massage will increase venous congestion and swelling.”
B. “Massage may dislodge the clot and cause a pulmonary embolism.”
C. “Massage interferes with anticoagulant effectiveness.”
D. “Massage worsens venous valve damage.”
B. “Massage may dislodge the clot and cause a pulmonary embolism.”