Nokea
Which of the following nursing actions should be included in the plan of care for a patient who has had endovascular repair of an abdominal aortic aneurysm?
- A. Record hourly chest tube drainage.
- B. Monitor fluid intake and urine output.
- C. Check the abdominal wound for redness or swelling.
- D. Teach the reason for a prolonged rehabilitation process.
Correct Answer: B
Rationale: Because renal artery occlusion can occur after endovascular repair, the nurse should monitor parameters of renal function such as intake and output. Chest tubes will not be needed for endovascular surgery, the recovery period will be short, and there will not be an abdominal wound.
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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.
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.
Which of the following patient statements indicates a need for further teaching about management of peripheral artery disease (PAD)?
- A. I will have to buy some loose clothing that does not bind across my legs or waist.
- B. I will use a heating pad on my feet at night to increase the circulation and warmth in my feet.
- C. I will walk to the point of pain, rest, and walk again until I develop pain for a half hour daily.
- D. I will change my position every hour and avoid long periods of sitting with my legs down.
Correct Answer: B
Rationale: Because the patient has impaired circulation and sensation to the feet, the use of a heating pad could lead to burns. The other patient statements are correct and indicate that teaching has been successful.
The health care provider prescribes an infusion of argatroban and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). Which of the following actions should the nurse include in the plan of care?
- A. Avoid giving any IM medications to prevent localized bleeding.
- B. Discontinue the infusion for PTT values greater than 50 seconds.
- C. Monitor posterior tibial and dorsalis pedis pulses with the Doppler.
- D. Have vitamin K available in case reversal of the argatroban is needed.
Correct Answer: A
Rationale: IM injections are avoided in patients receiving anticoagulation. A PTT of 50 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by 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.