Pripheral Vascular Management

Question 1: A nurse is providing education to a patient with peripheral artery disease (PAD). Which of the following statements made by the patient indicates the need for further teaching? A) “I will walk until I experience pain, then rest, and continue walking once the pain subsides.” B) “I need to avoid using heating pads on my legs to improve circulation.” C) “I will elevate my legs above the level of my heart to reduce swelling.” D) “I will stop smoking to improve my circulation.” Answer: C Rationale: Patients with PAD should avoid elevating the legs above the level of the heart as it can reduce arterial blood flow to the extremities. Elevating legs is recommended for venous conditions, not arterial insufficiency. The other options correctly indicate management of PAD. NCLEX Preference: Patient education regarding lifestyle modifications and proper management of PAD is a key concept tested in the NCLEX exam. ________________________________________ Question 2: The nurse is assessing a patient with chronic venous insufficiency. Which of the following findings would the nurse expect? A) Cool, pale skin B) Brown discoloration of the skin on the lower legs C) Thickened toenails D) Decreased pedal pulses Answer: B Rationale: Chronic venous insufficiency often leads to stasis dermatitis, which causes brownish skin discoloration on the lower legs. Cool, pale skin and decreased pulses are more associated with arterial insufficiency, and thickened toenails are more related to fungal infections or chronic arterial insufficiency. NCLEX Preference: Recognizing symptoms and appropriate management for venous versus arterial conditions is emphasized in the NCLEX. ________________________________________ Question 3: A patient with deep vein thrombosis (DVT) is started on heparin therapy. Which of the following laboratory values should the nurse monitor to determine the therapeutic effectiveness of the medication? A) Prothrombin time (PT) B) Hemoglobin C) International normalized ratio (INR) D) Activated partial thromboplastin time (aPTT) Answer: D Rationale: Heparin's effectiveness is monitored by the activated partial thromboplastin time (aPTT). APTT is prolonged when heparin is at therapeutic levels. PT and INR are used to monitor warfarin therapy. Hemoglobin is not used to monitor anticoagulation. NCLEX Preference: Monitoring lab values for patients on anticoagulation therapy is a frequent test item, particularly distinguishing between PT/INR (warfarin) and aPTT (heparin). ________________________________________ Question 4: The nurse is caring for a patient who underwent an abdominal aortic aneurysm (AAA) repair. The nurse should monitor for which of the following complications in the immediate postoperative period? A) Increased urine output B) Hypotension and tachycardia C) Warm, flushed skin D) Hyperactive bowel sounds Answer: B Rationale: Hypotension and tachycardia could indicate bleeding or shock, which are common complications after AAA repair. The other options are not typically seen in the immediate postoperative period of AAA surgery. NCLEX Preference: The NCLEX frequently tests knowledge of post-surgical complications, including recognition and management of hemorrhage and shock. ________________________________________ Question 5: A nurse is teaching a patient with newly diagnosed Raynaud’s disease. Which of the following instructions should the nurse include? A) “It is important to avoid exposure to cold temperatures.” B) “You should walk daily to improve circulation to your feet.” C) “You should apply heating pads directly to your fingers during an attack.” D) “Reduce your salt intake to control your symptoms.” Answer: A Rationale: Raynaud’s disease involves vasospasm in the fingers and toes, often triggered by cold temperatures. Avoiding cold exposure is a key preventive measure. Heating pads should be used with caution to avoid burns. Salt intake does not directly impact Raynaud’s symptoms. NCLEX Preference: Patient education about managing chronic conditions like Raynaud’s disease is often tested, focusing on avoiding triggers and appropriate interventions. ________________________________________ Question 6: The nurse is providing discharge instructions to a patient after surgical bypass for peripheral artery disease (PAD). Which of the following instructions is most important to prevent complications? A) “You should wear compression stockings daily.” B) “Avoid bending your knees excessively for prolonged periods.” C) “You should increase your fluid intake to 3 liters a day.” D) “It is essential to perform frequent leg exercises and elevate the legs often.” Answer: B Rationale: Bending the knees excessively can impede blood flow and cause complications such as clot formation. While leg exercises are important, elevating the legs is not recommended for PAD as it can reduce arterial flow. Compression stockings are not typically recommended for PAD unless there is venous insufficiency. NCLEX Preference: Post-surgical care, especially patient education regarding prevention of vascular complications, is highly tested. ________________________________________ Question 7: A patient is diagnosed with an acute deep vein thrombosis (DVT). Which of the following interventions should the nurse implement first? A) Encourage ambulation to promote circulation B) Apply warm compresses to the affected area C) Elevate the affected extremity above heart level D) Massage the affected area to relieve pain Answer: C Rationale: Elevating the affected extremity reduces swelling and promotes venous return. Ambulation should be delayed until anticoagulation therapy has been initiated. Massage is contraindicated as it can dislodge a clot and cause a pulmonary embolism. NCLEX Preference: Immediate management of DVT and preventing complications like pulmonary embolism is a common focus in NCLEX. Question 8: A nurse is caring for a patient who is receiving warfarin for the management of a deep vein thrombosis (DVT). Which dietary instruction should the nurse provide to the patient? A) “You should avoid all foods that contain vitamin K.” B) “Eat a consistent amount of leafy green vegetables.” C) “Increase your intake of foods rich in vitamin K.” D) “Avoid all fruits, especially citrus, while on this medication.” Answer: B Rationale: Warfarin affects blood clotting, and vitamin K can interfere with its action. Patients should maintain a consistent intake of vitamin K-rich foods (such as leafy green vegetables) to avoid fluctuations in their INR levels. The other options provide incorrect information about diet and warfarin management. NCLEX Preference: The NCLEX often tests patient education regarding warfarin therapy, particularly about diet, INR monitoring, and the effects of vitamin K. ________________________________________ Question 9: The nurse is caring for a patient with peripheral artery disease (PAD) who reports leg pain when walking but relief after rest. The nurse recognizes this as which of the following? A) Rest pain B) Intermittent claudication C) Venous insufficiency D) Neurogenic pain Answer: B Rationale: Intermittent claudication is a classic symptom of PAD, where the patient experiences pain while walking due to insufficient blood flow but finds relief during rest. Rest pain occurs later in the disease and usually indicates more severe arterial insufficiency. NCLEX Preference: Recognizing and differentiating types of pain related to vascular conditions is essential for the NCLEX. ________________________________________ Question 10: A nurse is preparing to administer enoxaparin to a patient with a deep vein thrombosis (DVT). Which site is the most appropriate for subcutaneous injection? A) The deltoid muscle B) The abdomen, 2 inches away from the umbilicus C) The thigh muscle D) The buttock Answer: B Rationale: Enoxaparin (a low molecular weight heparin) is typically given as a subcutaneous injection in the abdomen, avoiding areas near the umbilicus. This ensures effective absorption and minimizes the risk of complications. The other sites are inappropriate for enoxaparin administration. NCLEX Preference: Correct medication administration techniques, including site selection, are frequently tested in NCLEX questions.