Arterial/Venous Vascular Disorders - QUESTIONS

The nurse is admitting a 68-year-old preoperative patient with a suspected abdominal aortic aneurysm (AAA). The medication history reveals that the patient has been taking warfarin (Coumadin) on a daily basis. Based on this history and the patient's admission diagnosis, the nurse should prepare to administer which medication? A. Vitamin K B. Cobalamin C. Heparin sodium D. Protamine sulfate

A.

Which actions could the nurse delegate to unlicensed assistive personnel (UAP) who are providing care for a patient who is at risk for venous thromboembolism? a. Monitor for any bleeding after anticoagulation therapy is started. b. Apply sequential compression device whenever the patient is in bed. c. Ask the patient about use of herbal medicines or dietary supplements. d. Instruct the patient to call immediately if any shortness of breath occurs.

ANS: B UAP training includes the use of equipment that requires minimal nursing judgment, such as sequential compression devices. Patient assessment and teaching require more education and critical thinking and should be done by the registered nurse (RN).

The nurse performing an assessment with 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. a serosanguineous drainage from the ulcer.

ANS: C 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.

Which assessment finding for a patient who has been admitted with a right calf venous thromboembolism (VTE) requires immediate action by the nurse? a. Erythema of right lower leg b. Complaint of right calf pain c. New onset shortness of breath d. Temperature of 100.4° F (38° C)

ANS: C New onset dyspnea suggests a pulmonary embolus, which will require rapid actions such as oxygen administration and notification of the health care provider. The other findings are typical of VTE.

A 73-year-old 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 a. apply a compression stocking to the leg. b. elevate the leg above the level of the heart. c. assist the patient in gently exercising the leg. d. keep the patient in bed in the supine position.

ANS: D The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen 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 for the tissues of the leg.

A 46-year-old is diagnosed with thromboangiitis obliterates (Buerger's disease). When the nurse is developing a discharge teaching plan for the patient, which 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.

a. Cessation of all tobacco use.-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 for this disease.

A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which group of medications will the nurse plan to include when providing patient teaching about PAD management?a. Statins. b. Antibiotics. c. Thrombolytics. d. Anticoagulants.

a. Statins.-Current research indicates that statin use by patients with PAD improves multiple outcomes.

After teaching a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition, which action by the patient demonstrates that the teaching has been effective? a. The patient exercises indoors during the winter months. b. The patient places the hands in hot water when they turn pale. c. The patient takes pseudophedrine (Sudafed) for cold symptoms. d. The patient avoids taking NSAID's.

a. The patient exercises indoors during the winter months.-Patients should avoid temperature extremes by exercising indoors when it's cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the hands. Pseudophedrine is a vasoconstrictor, and should be avoided. There is no reason to avoid taking NSAID's with Raynaud's phenomenon.

The nurse is caring for a patient with critical limb ischemia who has just arrived on the nursing unit after having percutaneous transluminal balloon angioplasty. Which action should the nurse perform first? a. Begin oral intake. b. Obtain vital signs. c. Assess pedal pulses. d. Start discharge teaching.

b. Obtain vital signs./Take the blood pressure and pulse rate.-Bleeding is a possible complication after catheterization of the femoral artery, so the nurse's first action should e to assess for changes in VS that might indicate hemorrhage. The other actions are also appropriate but can be done after determining that bleeding is not occurring

The HCP prescribes an infusion of heparin (Hep-Lock) 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 any IM medications to prevent localized bleeding. c. monitor posterior tibial and dorsalis pedis pulses with the Doppler. d. have vitamin K available in case reversal of the heparin is needed.

b. avoid giving any IM medications to prevent localized bleeding.-IM injections are avoided in patients receiving anticoagulation. A PTT of 65 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affect by VTE.

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. have to buy some loose clothes that do not bend across my legs or waist." b. use a heating pad on my feet at night to increase circulation and warmth in my feet." c. change my position every hours and avoid long periods of sitting with my legs crossed." d. walk to the point of pain, rest, and walk again until the pain returns for at least 30 minutes 3 times a week."

b. use a heating pad on my feet at night to increase circulation and warmth in my feet."-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.

A patient with a 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 appropriate? a. "Taking two blood thinner reduces the risk for another clot to form." b. "Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots from forming." c. "Lovenox will work right away, but Coumadin takes several days to have an effect on preventing clots." d. "Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner."

c. "Lovenox will work right away, but Coumadin takes several days to have an effect on preventing clots."-Low molecular weight herparin (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 of pulmonary embolism, and two are not necessary to reduce the risk for another VTE. Furthermore, anticoagulants should not be described as blood thinners.

A 23-year-old patient tells the HCP 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. b. hyperlipidemia. c. autoimmune disorders. d. coronary artery disease.

c. autoimmune disorders.-Secondary Raynaud's phenomenon may occur in conjunction with autoimmune diseases such as rheumatoid arthritis. Patients should be screen for autoimmune disorders. Raynaud's phenomenon is not associated with hyperlipidemia, hyperglycemia, or CAD.

While working in the outpatient clinic, the nurse notes that a patient has a history of intermittent claudication. Which statement by the patient would support this information? a. "When I stand too long, my feet start to swell." b. "I get short of breath when I climb a lot of stairs." c. "My fingers hurt when I go outside in cold weather." d. "My legs cramp whenever i walk more than a block."

d. "My legs cramp whenever i walk more than a block."-Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication. Finger pain associated with cold weather is typical of Raynaud's phenomenon. Shortness of breath that occurs with exercise is not typical of intermittent claudication, which is reproducible. Swelling associated with prolonged standing is typical of venous disease.

The nurse reviews the admission orders shown in the accompanying figure for a patient newly diagnosed with PAD. Which admission order should the nurse question? a. Use of treadmill for exercise. b. Referral for dietary instruction. c. Exercising to the point of discomfort. d. Combined clopidogrel and omeprazole therapy.

d. Combined clopidogrel and omeprazole therapy.-Because he anti platelet effect of clopidogrel is reduced when it is used with omeprazole, the nurse should clarify this prescription with the HCP. The other interventions are appropriate for a patient with PAD.

The HCP 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.

d. One pillow is placed under the thighs and two pillows are placed under the lower legs.-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 patient at the clinic says, "I have always taken a 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. check 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. assess/attempt to palpate for the presence of the dorsalis pedis and posterior tibial pulses.

d. assess for the presence of the dorsalis pedis and posterior tibial 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 swelling, redness, and tenderness indicate venous thromboembolism (VTE).

The nurse is reviewing discharge instructions with a patient who is taking warfarin (Coumadin) as treatment for venous thromboembolism (VTE). Which substances will the patient need to avoid while taking warfarin? Select all that apply. 1. Aspirin 2. Gingko biloba 3. Fish oil supplements 4. Acetaminophen (Tylenol) 5. Foods containing vitamin K

1, 2, 3 The patient on oral anticoagulants needs to be taught to avoid taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), fish oil supplements, garlic supplements, ginkgo biloba, and certain antibiotics. Acetaminophen can be taken with oral anticoagulants. Foods containing vitamin K can be eaten as long as the intake of these foods is consistent.

A nurse is providing care for a patient who is diagnosed with mild hypertension. The severity of peripheral artery disease (PAD) in the patient ranges between 0.90-0.71 and the ankle brachial index (ABI) measurement ranges between 1.00-1.40. In addition to a prescription for thiazides, what else will be included on the patient's treatment plan? Select all that apply. 1. Advising the patient to reduce dietary sodium 2. Advising the patient to exercise daily 3. Advising the patient to avoid a high cholesterol diet 4. Administering omeprazole (Prilosec) to prevent side effects of thiazides 5. Administering angiotensin converting enzyme (ACE) inhibitors

1, 2, 3, 5 The PAD severity range and a normal ABI ratio suggest that the patient has mild symptoms of the disease. The patient can be managed with diet restrictions and lifestyle changes. The patient should reduce the intake of sodium to prevent water retention. The patient should exercise daily to keep active and prevent weight gain. A high cholesterol diet should be avoided as it can worsen hypertension. The patient can be treated with the combination of angiotensin converting enzyme (ACE) inhibitors and low doses of thiazides. These two drugs act together to treat hypertension, which is the primary cause of PAD. Omeprazole is used to treat gastroesophageal reflux disease and does not abate the side effects of thiazides.

A diabetic patient is being discharged after distal peripheral bypass surgery below the knee. Which instructions should the nurse include when talking to the patient and caregiver before discharge? Select all that apply. 1. Encourage supervised exercise training. 2. Teach the importance of foot care. 3. Instruct the patient to stand and relax for several minutes between walks. 4. Instruct the patient to visit a podiatrist if required. 5. Ask the patient to wear pointed shoes with soft insoles.

1, 2, 4 The nurse should encourage supervised exercise training to improve a number of cardiovascular disease risk factors, including hypertension, hyperlipidemia, obesity, and glucose levels. Meticulous foot care is important to prevent infection, especially in a diabetic patient. Thick or overgrown toenails and calluses are potentially serious and require regular attention by a podiatrist. The patient should take several short walks a day and rest between activities but avoid prolonged standing. The patient should be encouraged to wear comfortable shoes with rounded toes and soft insoles.

The nurse is examining a female patient who experiences leg edema and pain. What assessment findings indicate to the nurse that the patient is at a high risk for venous thromboembolism (VTE)? Select all that apply. 1. The patient is addicted to tobacco 2. The patient has been taking oral contraceptives 3. The patient has been taking aspirin daily for one year 4. The patient has a family history of VTE 5.The patient underwent peripheral artery disease (PAD) surgery

1, 2, 4, 5 A 36-year old woman who uses oral contraceptives and tobacco is at high risk for VTE. These compounds may cause hypercoagulability and may activate the intrinsic coagulation pathway that leads to deep vein thrombosis and pulmonary embolism. The risk increases if the patient has a family history of VTE, as the patient may carry the mutated genes responsible for the disease. PAD surgery has no direct relation to this disease, but if the endothelium is damaged during the surgery, it can initiate the coagulation cascade. Some medications, such as corticosteroids, may stimulate thrombus formation, but aspirin has shown no such tendency.

A patient is diagnosed with chronic venous insufficiency (CVI). When developing the plan of treatment, in which order should the nurse perform interventions to provide the most effective care to the patient? 1. Choose an appropriate compression therapy 2. Evaluate the efficiency of interventions on a regular basis 3. Teach the patient about the significance of a balanced diet 4. Assess the patient to determine the severity level of the disease

1, 3, 2, 4 The nurse should assess the patient before determining any treatment plan. Most patients suffering with CVI can be treated by conventional methods. These methods include applying moisturizer to prevent itching and cracking of the skin, and starting a balanced diet that includes proteins, carbohydrates, vitamins, and micronutrients to boost immunity and improve the healing process. In more severe cases, compression therapy can be started; however, each patient should be evaluated before the nurse determines the type of therapy. If the patient has peripheral arterial disease, a high level of compression should not be used, as it may induce extra pressure on arteries. This therapy is used to heal venous ulcers and to prevent recurrence. Routine evaluations are desirable to check the efficiency of the therapy.

The nurse is monitoring a postoperative patient for venous thromboembolism (VTE). Which are probable clinical findings in a person with VTE? Select all that apply. 1. Venous distention 2.Vein appears as a palpable cord 3. Deep reddish color to the affected area 4. Itchiness and warmth over the affected area 5. Tenderness to pressure over the involved vein

1, 3, 5 Clinical findings for VTE include tenderness to pressure over involved vein, induration of overlying muscle, venous distention, edema, possible mild to moderate pain, and a deep reddish color to area caused by venous congestion. Itchiness and cord-like texture are characteristics of superficial venous thrombosis.

What medications should the nurse expect to include in the teaching plan for the patient to decrease the risk of cardiovascular events and death for peripheral artery disease (PAD) patients? Select all that apply. 1. Ramipril (Altace) 2. Cilostazol (Pletal) 3. Simvastatin (Zocor) 4. Clopidogrel (Plavix) 5. Warfarin (Coumadin) 6. Aspirin (acetylsalicylic acid)

1, 3, 6 Angiotensin-converting enzyme inhibitors (e.g., ramipril) are used to control hypertension. Statins (e.g., simvastatin) are used for lipid management. Aspirin is used as an antiplatelet agent. Cilostazol is used for intermittent claudication, but it does not reduce cardiovascular disease (CVD) morbidity and mortality risks. Clopidogrel may be used if the patient cannot tolerate aspirin. Anticoagulants (e.g., warfarin) are not recommended to prevent CVD events in PAD patients.

A patient presents with claudication, pain in the legs and numbness of the feet. The patient is diagnosed with peripheral arterial disease (PAD). The nurse expects that what will be included in the patient's treatment plan? Select all that apply. 1. Antiplatelet therapy 2. Exercise therapy 3. Nutritional therapy 4. Sympathectomy 5. Calcium channel blockers

1,2,3

A patient is discharged from the hospital after undergoing femoral artery bypass surgery with synthetic graft replacement. The nurse reviews with the patient the signs and symptoms of acute arterial ischemia that occur with graft occlusion. Which is a sign of acute arterial occlusion? Select all that apply. 1. Pulse rate of 110 2. Leg is pale and white 3. Severe pain in the lower leg4Oral temperature of 38.2 º C 5. No hair growth on lower legs 6. Redness along the surgical incision

2, 3 Clinical signs and symptoms of acute arterial ischemia are the "six Ps": pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (leg is the temperature of the environment or cooler). A pale, white limb and severe pain are signs of acute arterial ischemia. A tachycardic heart rate of 110 and oral temperature of 38.2º C are consistent with an infection. No hair growth on legs occurs with chronic decreased circulation. A reddened incision is consistent with inflammation or infection.

The nurse is caring for a patient in the recovery area following a femoral-posterior tibial bypass graft. Which interventions should the nurse perform for the patient? Select all that apply. 1. Take ankle-brachial index (ABI) measurement. 2. Obtain palpable pulses. 3. Check sensation and movement. 4. Inspect operative extremity every 15 minutes. 5. Place the patient in a knee-flexed position.

2, 3, 4 When caring for the patient in the recovery area, the nurse should obtain palpable pulses, check sensation and movement of extremities, and inspect operative extremity every 15 minutes. Postoperative ABI measurements are not recommended, as they place the patient at risk for graft thrombosis. In the recovery area, the patient is not placed in a knee-flexed position; this position is adopted only during exercise 1 day postsurgery in the absence of complications.

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? 1. Keep the patient on bed rest 2. Assist the patient with walking several times 3. Have the patient sit in the chair several times 4. Place the patient on her side with knees flexed

2. 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 patient experiences pain in the calf while exercising and reports that the pain disappears after a few minutes of resting. The nurse recognizes the finding as most consistent with: 1. Venous obstruction in the leg 2. Claudication resulting from venous abnormalities 3. Ischemia resulting from complete blockage of an artery 4. Ischemia resulting from partial blockage of an artery

4 Ischemia is a deficient supply of oxygenated arterial blood to tissue. A partial blockage creates an insufficient supply, and the ischemia may be apparent only during exercise, when oxygen needs increase. Claudication does not result from venous abnormalities. Ischemic pain would not disappear with a complete blockage of an artery in the leg; the pain would be constant.

Assessment of a patient's peripheral intravenous (IV) site reveals that phlebitis has developed over the past several hours. Which intervention should the nurse implement first? A. Remove the patient's IV catheter B. Apply an ice pack to the affected area C. Decrease the IV rate to 20 to 30 mL/hr D. Administer prophylactic anticoagulants

A. Remove the patient's IV catheter The priority intervention for superficial phlebitis is removal of the offending IV catheter. Decreasing the IV rate is insufficient. Anticoagulants normally are not required, and warm, moist heat often is therapeutic.

A 67-year-old patient is admitted to the hospital with a diagnosis of venous insufficiency. Which patient statement is most supportive of the diagnosis? a. "I can't get my shoes on at the end of the day." b. "I can't seem to ever 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 (PAD).

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.

The nurse is preparing to administer a scheduled dose of enoxaparin (Lovenox) 30 mg subcutaneously. What should the nurse do to administer this medication correctly? A Remove the air bubble in the prefilled syringe. B Aspirate before injection to prevent intravenous (IV) administration. C Rub the injection site after administration to enhance absorption. D Pinch the skin between the thumb and forefinger before inserting the needle.

D

The nurse would determine that the patient is not receiving the beneficial effects of enoxaparin (Lovenox) after noting which finding during a routine shift assessment? A. Generalized weakness B. Abdominal pain C. Crackles bilaterally in the lung bases D. Swelling of the right leg

D. Swelling of the right leg Enoxaparin is a low-molecular weight heparin used to prevent the development of deep-vein thromboses in the postoperative period. Homans' sign (pain in the calf on dorsiflexion of the foot) can indicate development of deep-vein thrombosis and may signal ineffective medication therapy. Generalized weakness, crackles in the lungs, and abdominal pain do not indicate lack of effectiveness of this anticoagulant.

The patient reports tenderness when the patient touches the leg over a vein. The nurse assesses warmth and a palpable cord in the area. The nurse knows the patient needs treatment to prevent what? A. Pulmonary embolism B. Pulmonary hypertension C. Postthrombotic syndrome D. Venous thromboembolism

D. The clinical manifestations are characteristic of a superficial vein thrombosis. If untreated, the clot may extend to deeper veins and venous thromboembolism may occur. Pulmonary embolism, pulmonary hypertension, and postthrombotic syndrome are the sequelae of venous thromboembolism.

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 an LPN/LVN caring for the patient requires the RN to intervene? a. The LPN/LVN has the patient sit in a chair for 90 minutes. b. The LPN/LVN assists the patient to walk 40 feet in the hallway. c. The LPN/LVN gives the ordered aspirin 160 mg after breakfast. d. The LPN/LVN placed the patient in a Fowler's position for meals.

a. The LPN/LVN has the patient sit in a chair for 90 minutes.-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 VTE. The other actions are appropriate.

The nurse has started discharge teaching for a patient who is to continue warfarin (Coumadin) following 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 Coumadin." b. "I should reduce the amount of greed, leafy vegetables that I eat." c. "I will need routine blood tests to monitor the effects of the Coumadin." d. "I will check with my health care provider before I begin any new medications."

b. "I should reduce the amount of greed, leafy vegetables that I eat."-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.

When developing a teaching plan for a 76-year-old patient newly diagnosed with peripheral artery disease (PAD), which instructions should the nurse include? a. "Exercise only if you do not experience any pain." b. "It is very important that you stop smoking cigarettes." c. "Try to keep your legs elevated whenever you are sitting." d. "Put elastic compression stockings on early in the morning."

b. "It is very important that you stop smoking cigarettes."-Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.

The nurse performing an assessment with 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. a serosanguineous drainage from the ulcer.

c. 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 73-year-old with chronic A-Fib develops sudden severe pain, pulselessness, pallor, and coolness in the right leg. The nurse should notify the HCP and immediately. a. apply a compression stocking to the leg. b. elevate the leg above the level of the heart. c. assist the patient in gently exercising the leg. d. keep the patient in bed in the supine position.

d. keep the patient in bed in the supine position.-The patient's history and clinical manifestations are consistent with acute arterial occlusion, and resting the leg will decrease the oxygen 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 for the tissues of the leg.