ATI med surg ch 35: peripheral vascular diseases questions

1. A nurse is caring for a client who has chronic venous insufficiency and a prescription for thigh-high compression stockings. Which of the following actions should the nurse take? A. Massage both legs firmly with lotion prior to applying the stockings. B. Apply the stockings in the morning upon awakening and before getting out of bed. C. Roll the stockings down to the knees to relieve discomfort on the legs. D. Remove the stockings while out of bed for 1 hr, four times a day, to allow the legs to rest.

1. A. Massaging the affected area can dislodge a clot and cause an embolism. B. CORRECT: Applying stockings in the morning upon awakening and before getting out of bed reduces venous stasis and assists in the venous return of blood to the heart. Legs are less edematous at this time. C. Rolling stockings down can restrict circulation and cause edema. D. Stockings should remain in place throughout the day and are removed before going to bed to provide continuous venous support. If the stockings are removed, such as for a bath or shower, then the legs should be elevated before the stockings are reapplied.

2. A nurse is assessing a client who has chronic peripheral arterial disease (PAD). Which of the following findings should the nurse expect? A. Edema around the ankles and feet B. Ulceration around the medial malleoli C. Scaling eczema of the lower legs with stasis dermatitis D. Pallor on elevation of the limbs, and rubor when the limbs are dependent

2. A. Edema around the ankles and feet is an expected finding in a client who has venous stasis. B. Ulceration around the medial malleoli is an expected finding in a client who has venous stasis. C. Scaling eczema of the lower legs with stasis dermatitis is an expected finding in a client who has venous stasis. D. CORRECT: In a client who has chronic PAD, pallor is seen in the extremities when the limbs are elevated, and rubor occurs when they are lowered.

3. A nurse is teaching a client who has been a new diagnosis of severe peripheral arterial disease. Which of the following instructions should the nurse include? A. Wear tightly fitted insulated socks with shoes when going outside. B. Elevate both legs above the heart when resting. C. Apply a heating pad to both legs for comfort. D. Place both legs in dependent position while sleeping.

3. A. While insulated socks can promote warmth, they should be loose fitting to promote circulation. B. The client should avoid elevating the legs above the heart while resting. This can cause a restriction in arterial blood flow to the feet. C. The client should not apply a heating pad to his legs due to the loss in sensation as a result of the disease. Applying direct heat to the legs can burn the client. D. CORRECT: The nurse should instruct the client to place his legs in a dependent position, such as hanging off the edge of the bed while sleeping. This can alleviate swelling and discomfort of the legs.

4. A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Avoid the consuming grapefruit while taking this medication. B. Monitor for the presence of black, tarry stools. C. Use an electric razor when shaving. D. Schedule a weekly PT test. E. Limit food sources containing vitamin K while taking this medication.

4. A. CORRECT: The nurse should instruct the client to avoid consuming grapefruit while taking clopidogrel. Grapefruit interferes with absorption of clopidogrel and can cause severe complications. B. CORRECT: The nurse should instruct the client to monitor for evidence of GI bleeding, such as abdominal pain, coffee-ground emesis, or black, tarry stools. If this occurs, the client should report this to the provider. C. Bleeding precautions are required for a client taking anticoagulants, not antiplatelet medications. D. PT and INR levels are monitored regularly in a client taking warfarin. E. A client who is taking warfarin should be advised

5. A nurse is caring for a client who has a deep-vein thrombosis (DVT) and has been taking unfractionated heparin for 1 week. Two days ago, the provider also prescribed warfarin. The client asks the nurse about receiving both heparin and warfarin at the same time. Which of the following statements should the nurse give? A. "I will remind your provider that you are already receiving heparin." B. "Your laboratory findings indicated that two anticoagulants were needed." C."It takes 3 to 4 days before the therapeutic effects of warfarin are achieved, and then the heparin can be discontinued." D."Only one of these medications is being given to treat your deep-vein thrombosis."

5. A. Warfarin is prescribed for 3 to 4 days before discontinuing IV heparin. B. IV heparin is monitored to achieve adequate therapeutic levels in treating a DVT. C. CORRECT: Warfarin depresses synthesis of clotting factors but does not have an effect on clotting factors that are present. It takes 3 to 4 days for the clotting factors that are present to decay and for the therapeutic effects of warfarin to occur. D. Heparin and warfarin are both effective in treating DVT.