Nokea
The nurse is developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD). Which of the following information 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 on support hose early in the day before swelling occurs.
Correct Answer: B
Rationale: 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.
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The nurse is obtaining a health history from a patient who has a 5-cm thoracic aortic aneurysm that was discovered during a routine chest x-ray. Which of the following symptoms should the nurse expect to assess in the patient?
- A. Back or lumbar pain
- B. Difficulty swallowing
- C. Abdominal tenderness
- D. Changes in bowel habits
Correct Answer: B
Rationale: Difficulty swallowing may occur with a thoracic aneurysm because of pressure on the esophagus. The other symptoms will be important to assess for in patients with abdominal aortic aneurysms.
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.
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.
The nurse is caring for a patient with a right calf venous thromboembolism. Which of the following information requires immediate action by the nurse?
- A. Complaint of left calf pain
- B. New onset shortness of breath
- C. Red skin colour of left lower leg
- D. Temperature of 38°C (100.4°F)
Correct Answer: B
Rationale: 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.
Which of the following responses by a patient who is on anticoagulant therapy indicates the need for further teaching?
- A. I can still have a glass of wine with my dinner.
- B. For pain relief I will take ibuprofen.
- C. I take my pills at two o'clock every day.
- D. I will use an electric razor for shaving.
Correct Answer: B
Rationale: Patients on anticoagulant therapy should avoid all NSAIDs; therefore ibuprofen should not be taken for pain relief. It is acceptable to have an alcohol intake of a glass of wine daily. It is important that medications be taken at the same time every day. Patients are taught to avoid the use of a straight razor.