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Which of the following patients in the emergency department should the nurse assess first?
- A. 62-year-old who has gangrenous ulcers on both feet
- B. 50-year-old who is complaining of 'tearing' chest pain.
- C. 45-year-old who is taking anticoagulants and has bloody stools
- D. 36-year-old who has right calf tenderness, redness, and swelling
Correct Answer: B
Rationale: The patient's presentation is consistent with aortic dissection, which will require rapid intervention. The other patients do not need urgent interventions.
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A patient in the outpatient clinic has a new diagnosis of peripheral artery disease (PAD). Which of the following medication categories should the nurse plan to include when providing patient teaching about PAD management?
- A. Statins
- B. Vitamins
- C. Thrombolytics
- D. Anticoagulants
Correct Answer: A
Rationale: Current research indicates that statin use by patients with PAD improves multiple outcomes. There is no research that supports the use of the other medication categories in PAD.
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 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.
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.
Immediately after repair of an abdominal aortic aneurysm, a patient has absent popliteal, posterior tibial, and dorsalis pedis pulses. The legs are cool and mottled. Which of the following actions should the nurse take first?
- A. Wrap both the legs in warm blankets.
- B. Notify the surgeon and anaesthesiologist.
- C. Document that the pulses are absent and recheck in 30 minutes.
- D. Review the preoperative assessment form for data about the pulses.
Correct Answer: D
Rationale: Many patients with aortic aneurysms also have peripheral arterial disease, so the nurse should check the preoperative assessment to determine whether pulses were present before surgery before notifying the health care providers about the absent pulses. Because the patient's symptoms may indicate graft occlusion or multiple emboli and a possible need to return to surgery, it is not appropriate to wait 30 minutes before taking action. Warm blankets will not improve the circulation to the patient's legs.