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While working in the outpatient clinic, the nurse notes that the medical record states that a patient has intermittent claudication. Which of the following patient statements is consistent with this information?
- A. When I stand too long, my feet start to swell up.
- B. Sometimes I get tired when I climb a lot of stairs.
- C. My fingers hurt when I go outside in cold weather.
- D. My legs cramp whenever I walk more than a block.
Correct Answer: D
Rationale: Cramping that is precipitated by a consistent level of exercise is descriptive of intermittent claudication. Finger pain associated with cold weather is typical of Raynaud's phenomenon. Fatigue that occurs sometimes with exercise is not typical of intermittent claudication, which is reproducible. Swelling associated with prolonged standing is typical of venous disease.
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The nurse is assessing a patient who has chronic peripheral artery disease (PAD) of the legs and an ulcer on the left great toe. Which of the following findings should the nurse expect?
- A. A positive Homans' sign
- B. Swollen, dry, scaly ankles
- C. Prolonged capillary refill in all the toes
- D. A large amount of drainage from the ulcer
Correct Answer: C
Rationale: Capillary refill is prolonged in PAD because of the slower and decreased blood flow to the periphery. The other listed clinical manifestations are consistent with chronic venous disease.
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.
A patient at the clinic says, 'I have always taken an evening walk, but lately my leg cramps and hurts after just a few minutes of walking. The pain goes away after I stop walking, though.' Which of the following actions should the nurse implement?
- A. Attempt to palpate the dorsalis pedis and posterior tibial pulses.
- B. Check for the presence of tortuous veins bilaterally on the legs.
- C. Ask about any skin colour changes that occur in response to cold.
- D. Assess for unilateral swelling, redness, and tenderness of either leg.
Correct Answer: A
Rationale: The nurse should assess for other clinical manifestations of peripheral arterial disease in a patient who describes intermittent claudication. Changes in skin colour that occur in response to cold are consistent with Raynaud's phenomenon. Tortuous veins on the legs suggest venous insufficiency. Unilateral leg swelling, redness, and tenderness point to venous thromboembolism (VTE).
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.
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.