PAD OVD QUESIONS

The nurse reading the admission note for a client who has an arterial leg ulcer would anticipate that the ulcer will be characterized a. as being surrounded by atrophic tissue. b. as producing minimal pain. c. by a deep-red base. d. by irregular borders.

ANS: A Arterial leg ulcers are very painful, which distinguishes them from venous stasis ulcers. Arterial ulcers also have a sharp edge and a pale base and often are surrounded by atrophic tissue.

A nurse is assessing a client with peripheral artery disease (PAD). The client states walking five blocks is possible without pain. What question asked next by the nurse will give the best information? a. "Could you walk further than that a few months ago?" b. "Do you walk mostly uphill, downhill, or on flat surfaces?" c. "Have you ever considered swimming instead of walking?" d. "How much pain medication do you take each day?"

ANS: A As PAD progresses, it takes less oxygen demand to cause pain. Needing to cut down on activity to be pain free indicates the client's disease is worsening. The other questions are useful, but not as important.

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).

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

ANS: A Current research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other medication categories in PAD.

Which instruction is most appropriate for a patient with arterial insufficiency? a. Frequently allow the legs to dangle dependently. b. Rub the legs vigorously. c. Stand often to keep blood flow in the legs. d. Walk barefoot.

ANS: A Dangling legs can use gravity to help with arterial circulation. Vigorous rubbing of the legs is contraindicated, and prolonged standing strains the vascular system. The patient should never walk barefoot

The nurse explains to a client started on daily doses of Plavix after femoral bypass surgery that the purpose of this regimen is to a. decrease platelet aggregation. b. decrease postoperative pain. c. increase vasodilation in the legs. d. prevent postoperative fever.

ANS: A Medications that decrease platelet aggregation, such as aspirin and clopidogrel (Plavix), are used to increase the length of graft patency.

A nurse records the assessment of stasis dermatitis on an intake assessment for a patient with peripheral vascular disease (PVD). What is the best way to describe this finding? a. Brownish skin discoloration on the lower legs b. Ulceration on medial surface of the lower legs c. Edema in the lower legs d. Purple rash on medial surface of the lower legs

ANS: A Stasis dermatitis is a brownish skin discoloration on the lower legs, which is indicative of venous stasis.

What patient teaching should be included for a patient with varicose veins? a. Weight reduction b. Decreasing exercise c. Wearing a panty girdle d. Standing rather than sitting

ANS: A Varicose veins are caused by a dilation of incompetent valves. Obesity, pregnancy, restrictive clothing, and prolonged standing aggravate the condition.

What is a characteristic of a venous stasis ulcer? a. Painlessness b. Poikilothermy c. Pale color d. Location near the groin

ANS: A Venous ulcers are painless ulcers near the ankle that are warm and have a ruddy color.

The nurse teaches the client with intermittent claudication that the pain results from a. lactic and pyruvic acid buildup. b. muscle cramps. c. rapid vasodilation in the legs. d. venous stasis.

ANS: A Waste produced by lactic and pyruvic acid builds up quickly in oxygen-deprived muscles.

A nurse is caring for a client on IV infusion of heparin. What actions does this nurse include in the client's plan of care? (Select all that apply.) a. Assess the client for bleeding. b. Monitor the daily activated partial thromboplastin time (aPTT) results. c. Stop the IV for aPTT above baseline. d. Use an IV pump for the infusion. e. Weigh the client daily on the same scale.

ANS: A, B, D Assessing for bleeding, monitoring aPTT, and using an IV pump for the infusion are all important safety measures for heparin to prevent injury from bleeding. The aPTT needs to be 1.5 to 2 times normal in order to demonstrate that the heparin is therapeutic. Weighing the client is not related.

Why do older persons adapt more slowly to changes in the peripheral vascular system? (Select all that apply.) a. Slowing heart rate b. Decreasing cardiac output c. Increasing stroke volume d. Stiffening of blood vessels e. Thickening of aorta

ANS: A, B, D, E Age-related changes include a slowing of the heart rate, a decrease in both cardiac output and stroke volume, and a stiffening and thickening of blood vessels.

A nurse suspects a circulatory disorder in one leg. Which assessments should the nurse include when comparing both legs? (Select all that apply.) a. Color b. Warmth c. Muscle strength d. Pulse quality e. Hair loss on extremity

ANS: A, B, D, E Muscle strength is not a circulatory assessment. Color, warmth, pulse quality, and loss of superficial hair are indicators of decreased arterial perfusion.

Important health promotion measures a nurse could teach a client in order to avoid another episode of DVT include (Select all that apply) a. avoiding prolonged sitting. b. elevating the legs when sitting. c. maintaining an ideal body weight. d. remaining hydrated.

ANS: A, C, D Virchow's triad describes the pathophysiologic conditions that have to exist in order to have a DVT. The components are venous stasis (caused by immobilization, prolonged travel, pregnancy, lack of use of the calf muscle pump, and heart disease, among others), hypercoagulability (caused by dehydration, blood dyscrasias, and oral contraceptives, among other things), and vascular injury (caused by fractures, trauma, dislocations, and chemical irritation, among other things). Two of the three factors must be present to form a DVT.

The nurse working in the emergency department knows that which factors are commonly related to aneurysm formation? (Select all that apply.) a. Atherosclerosis b. Down syndrome c. Frequent heartburn d. History of hypertension e. History of smoking

ANS: A, D, E Atherosclerosis, hypertension, hyperlipidemia, and smoking are the most common related factors. Down syndrome and heartburn have no relation to aneurysm formation.

A nurse is caring for a client with a deep vein thrombosis (DVT). What nursing assessment indicates a priority outcome has been met? a. Ambulates with assistance b. Oxygen saturation of 98% c. Pain of 2/10 after medication d. Verbalizing risk factors

ANS: B A critical complication of DVT is pulmonary embolism. A normal oxygen saturation indicates that this has not occurred. The other assessments are also positive, but not the priority.

A 69-year-old patient reports a burning, aching pain in the legs when walking to the mailbox. These symptoms are relieved with rest. What should the nurse suspect? a. Venous insufficiency b. Claudication c. Phlebitis d. Rest pain

ANS: B Arterial vascular disorders that produce pain with activity are defined as claudication, which is the result of ischemia of the tissues caused by a lack of adequate perfusion.

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.

ANS: B Bleeding is a possible complication after catheterization of the femoral artery, so the nurse's first action should be to assess for changes in vital signs that might indicate hemorrhage. The other actions are also appropriate but can be done after determining that bleeding is not occurring.

A nurse assesses a patient's capillary refill time as less than 3 seconds. What does this assessment indicate? a. Hypertension b. Tissue perfusion c. Excess fluid volume d. Increased blood viscosity

ANS: B Capillary refill is determined by compressing the nail bed until it blanches. With a normal capillary refill, color returns to the blanched skin within 3 seconds.

Vascular disease disorders often require the use of elastic stockings. Which action should the nurse implement when caring for a patient with elastic stockings? a. Apply the stockings and roll down the cuff. b. Remove the stockings for skin inspection two times a day. c. Remove the stockings when the patient is ambulating. d. Inspect the skin for pressure or irritation daily.

ANS: B Elastic stockings improve blood flow. They should be applied early in the morning. They should be removed twice daily for 20 to 30 minutes, and the skin integrity of the feet should be examined.

The health care provider 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.

ANS: B 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 affected by VTE.

A nurse is preparing to administer low-molecular-weight heparin (LMWH). What is a major advantage related to the administration of LMWH? a. It can be given orally. b. It is provided fixed doses. c. It is given only after partial thromboplastin time (PTT) laboratory work. d. It provides an immediate effect.

ANS: B LMWH can be given as a fixed dose without waiting for the results of the PTT. It is only given subcutaneously and does not have an immediate effect. PTT is not done to monitor LMWH.

The nurse who works in the vascular clinic has several patients with venous insufficiency scheduled today. Which patient should the nurse assign to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Patient who has been complaining of increased edema and skin changes in the legs b. Patient who needs wound care for a chronic venous stasis ulcer on the right lower leg c. Patient who has a history of venous thromboembolism and is complaining of some dyspnea d. Patient who needs teaching about the use of elastic compression stockings for venous insufficiency

ANS: B LPN education and scope of practice includes wound care. The other patients, which require more complex assessments or education, should be managed by the RN.

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 green, 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."

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.

When a client with arterial insufficiency complains of being awakened at night by pain in the legs, the nurse would recommend that the client sleep a. after exercising for 10 to 15 minutes. b. in a recliner with feet dependent. c. propped up by several pillows. d. with legs covered by an extra blanket.

ANS: B Placing the legs in a dependent position provides increased gravitational blood supply.

An obese postsurgical patient complains of sudden discomfort in her leg. The nurse assesses the leg and finds it cold and pale with no pedal or popliteal pulse. What should the nurse suspect? a. Venous thrombosis b. Arterial occlusion c. Vascular spasm d. Paresthesia

ANS: B Signs of an acute arterial occlusion can include severe pain, absent pulses, or very pale or mottled skin.

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.

The nurse is caring for a client who is taking warfarin sodium (Coumadin) for a history of DVT. Before administering the medication, the nurse should assess the client's a. Homan's sign. b. PT, INR. c. PTT. d. vital signs.

ANS: B The PT and INR are used to monitor therapy with warfarin. The PTT is used to guide heparin therapy. The Homan's sign is not considered a very reliable assessment for DVT. The nurse administering either warfarin or heparin should know the results of the latest monitoring test before giving the client the drug in order to prevent possible complications if the level is too high.

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).

What nonpharmacologic comfort measures should the nurse include in the plan of care for a client with severe varicose veins? (Select all that apply.) a. Administering mild analgesics for pain b. Applying elastic compression stockings c. Elevating the legs when sitting or lying d. Reminding the client to do leg exercises e. Teaching the client about surgical options

ANS: B, C, D The three E's of care for varicose veins include elastic compression hose, exercise, and elevation. Mild analgesics are not a nonpharmacologic measure. Teaching about surgical options is not a comfort measure.

A client who is receiving IV heparin has a PTT reported by the lab as 101. Appropriate actions by the nurse include (Select all that apply) a. continuing to monitor the heparin infusion. b. instituting safety precautions. c. notifying the physician. d. ordering another PTT in the morning. e. turning off the heparin IV.

ANS: B, C, E Bleeding can occur in the client receiving anticoagulant therapy. Heparin infusions are monitored with the PTT. Therapeutic levels are generally greater than 60, but at 1.5-2.5 times the baseline (normal is around 25-35). A PTT of 101 is a critical result and the nurse should (1) stop the heparin infusion, (2) notify the physician, and (3) place the client on bleeding precautions. A small injury to the client can cause bleeding. The client can also have spontaneous bleeding. The nurse should observe the client for bleeding, as evidenced by frank hemorrhage, changes in mental status, pink-tinged or frank blood in the urine, dark or tarry stools, and bleeding after brushing the teeth.

The nurse would explain to a client that anticoagulant therapy is used in the treatment of thromboembolic disease because anticoagulants can a. decrease blood viscosity. b. dissolve the thrombi. c. inhibit the synthesis of clotting factors. d. prevent absorption of vitamin K.

ANS: C Anticoagulant therapy is based on the premise that the initiation or extension of thrombi can be prevented by inhibiting the synthesis of clotting factors or by accelerating their inactivation. The anticoagulants heparin and warfarin do not induce thrombolysis but effectively prevent clot extension.

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.

A nurse is assessing an obese client in the clinic for follow-up after an episode of deep vein thrombosis. The client has lost 20 pounds since the last visit. What action by the nurse is best? a. Ask if the weight loss was intended. b. Encourage a high-protein, high-fiber diet. c. Measure for new compression stockings. d. Review a 3-day food recall diary.

ANS: C Compression stockings must fit correctly in order to work. After losing a significant amount of weight, the client should be re-measured and new stockings ordered if needed. The other options are appropriate, but not the most important.

A 46-year-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 the patient who had just had sclerotherapy.

For a client with deep vein thrombosis (DVT), the nurse would include in the plan of nursing care the intervention of a. applying cool compresses to the area. b. maintaining the legs in the dependent position. c. raising the foot of the bed 6 inches. d. restricting fluids.

ANS: C Elevation of the legs decreases venous pressure, which in turn relieves edema and pain in the client with DVT. Warm compresses can be comforting. Restricting fluids is not in the plan of care.

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 mostappropriate? a. "Taking two blood thinners 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."

ANS: C 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. Furthermore, anticoagulants should not be described as blood thinners.

For a client admitted with a history of chronic arterial insufficiency, the nurse would anticipate that physical assessment will reveal a. rubor with elevation of feet. b. pallor when feet are dependent. c. diminished pedal pulses. d. warm, edematous skin.

ANS: C Objective data associated with arterial insufficiency include weak or absent peripheral pulses, dependent rubor, pallor with elevation, hypertrophied toenails, tissue atrophy, ulceration, and gangrene.

Which statements by the client indicate good understanding of foot care in peripheral vascular disease? (Select all that apply.) a. "A good abrasive pumice stone will keep my feet soft." b. "I'll always wear shoes if I can buy cheap flip-flops." c. "I will keep my feet dry, especially between the toes." d. "Lotion is important to keep my feet smooth and soft." e. "Washing my feet in room-temperature water is best."

ANS: C, D, E Good foot care includes appropriate hygiene and injury prevention. Keeping the feet dry; wearing good, comfortable shoes; using lotion; washing the feet in room-temperature water; and cutting the nails straight across are all important measures. Abrasive material such as pumice stones should not be used. Cheap flip-flops may not fit well and won't offer much protection against injury.

When a client complains of heaviness, aching, and itching of both legs for the past year, the nurse recognizes these complaints as being most suggestive of a. Buerger's disease. b. deep vein thrombosis. c. Raynaud's phenomenon. d. varicose veins.

ANS: D Clients with varicose veins complain of aching, a feeling of heaviness, itching, moderate swelling, and the often unsightly appearance of their legs.

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.

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."

ANS: D 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.

What should a nurse ask a patient related to past history of deep-vein thrombosis (DVT) and other vascular problems? a. An aneurysm b. Rheumatoid arthritis c. A peptic ulcer d. Recurring chest pain

ANS: D Pain in the chest or dyspnea suggests that a pulmonary embolism may have occurred from the presence of a DVT. Approximately 10% of individuals with DVT develop pulmonary emboli.

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 for the presence of the dorsalis pedis and posterior tibial pulses.

ANS: D 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

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.

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.