Nokea
The nurse is caring for a patient with peripheral artery disease who is Aspirin intolerant. Which of the following medications should the nurse anticipate the health care provider prescribing for the patient related to this intolerance?
- A. Pentoxifylline
- B. Clopidogrel
- C. Ramipril
- D. Warfarin
Correct Answer: B
Rationale: For patients who are Aspirin intolerant, clopidogrel (75 mg/day) is indicated. Pentoxifylline is used to treat intermittent claudication. Ramipril is an ACE inhibitor. Warfarin is an anticoagulant and is not recommended for the prevention of coronary artery disease in patients with PAD.
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The nurse is caring for a patient on the first postoperative day after an abdominal aortic aneurysm repair. Which of the following assessment findings is most important to communicate to the health care provider?
- A. Absence of flatus
- B. Loose, bloody stools
- C. Hypotonic bowel sounds
- D. Abdominal pain with palpation
Correct Answer: B
Rationale: Loose, bloody stools at this time may indicate intestinal ischemia or infarction and should be reported immediately because the patient may need an emergency bowel resection. The other findings are normal on the first postoperative day after abdominal surgery.
The nurse is providing teaching to a patient with newly diagnosed Raynaud's phenomenon about how to manage the condition. Which of the following behaviours by the patient indicates that the teaching has been effective?
- A. The patient avoids the use of Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).
- B. The patient exercises indoors during the winter months.
- C. The patient places the hands in hot water when they turn pale.
- D. The patient takes pseudoephedrine for cold symptoms.
Correct Answer: B
Rationale: Patients should avoid temperature extremes by exercising indoors when it is cold. To avoid burn injuries, the patient should use warm, rather than hot, water to warm the hands. Pseudoephedrine, a vasoconstrictor, should be avoided. There is no reason to avoid taking Aspirin and NSAIDs with Raynaud's phenomenon.
Several hours after an open surgical repair of an abdominal aortic aneurysm, the patient develops a urinary output of 20 mL/hour for 2 hours. Which of the following prescriptions should the nurse anticipate?
- A. An additional antibiotic
- B. White blood cell (WBC) count
- C. Decrease in IV infusion rate
- D. Blood urea nitrogen (BUN) level
Correct Answer: D
Rationale: The decreased urine output suggests decreased renal perfusion, and monitoring of renal function is needed. There is no indication that infection is a concern, so antibiotic therapy and a WBC count are not needed. The IV rate may be increased because hypovolemia may be contributing to the patient's decreased urinary output.
A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of the following patient statements is most consistent with this diagnosis?
- A. I can't get my shoes on at the end of the day.
- B. I can never seem to get my feet warm enough.
- C. I wake up during the night because my legs hurt.
- D. I have burning leg pains after I walk three blocks.
Correct Answer: A
Rationale: 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).
The nurse is caring for a patient with chronic atrial fibrillation who develops sudden severe pain, pulselessness, pallor, and coolness in the left leg. Which of the following actions should the nurse implement first?
- A. Elevate the left leg on a pillow.
- B. Apply an elastic wrap to the leg.
- C. Assist the patient in gently exercising the leg.
- D. Notify the health care provider.
Correct Answer: D
Rationale: The patient's history and clinical manifestations are consistent with acute arterial occlusion. Clinical manifestations of acute arterial ischemia include the 'six Ps': pain, pallor, paralysis, pulselessness, paresthesia, and poikilothermia (adaptation of the limb to the environmental temperature most often cool). Without immediate intervention, ischemia may progress quickly to tissue necrosis and gangrene within a few hours. If the nurse detects these signs, the nurse should immediately notify the health care provider. 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.