Ch.
38: Peripheral Vascular Disease NCLEX Questions
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A 50-year-old woman weighs 95 kg and has a history of tobacco
use, high blood pressure, high sodium intake, and sedentary
lifestyle.
When developing an individualized care plan for her, the
nurse determines that the most important risk factors for periph-
eral
artery disease (PAD) that need to be modified are:
a. weight and diet.
b. activity level and diet.
c. tobacco use and high blood pressure.
d. sedentary lifestyle and high blood pressure.
Rest pain is a manifestation of PAD that occurs due to a chronic
a. vasospasm of small cutaneous arteries in the feet.
b. increase in retrograde venous blood flow in the legs.
c. decrease in arterial blood flow to the nerves of the feet.
d. decrease in arterial blood flow to the leg muscles during
exercise.
A patient with infective endocarditis develops sudden left leg pain
with pallor, paresthesia, and a loss of peripheral pulses. The
nurse's
initial action should be to
a. elevate the leg to promote venous return.
b. start anticoagulant therapy with IV heparin.
c. notify the physician of the change in peripheral perfusion.
d. place the bed in reverse Trendelenburg to promote perfusion.
Which clinical manifestations are seen in patients with either
Buerger's disease or Raynaud's phenomenon (select all that ap-
ply)?
a. Intermittent fevers
b. Sensitivity to cold temperatures
c. Gangrenous ulcers on fingertips
d. Color changes of fingers and toes
e. Episodes of superficial vein thrombosis
A patient is admitted to the hospital with a diagnosis of abdominal
aortic aneurysm. Which signs and symptoms would suggest that
his aneurysm has ruptured?
a. Sudden shortness of breath and hemoptysis
b. Sudden, severe low back pain and bruising along his flank
c. Gradually increasing substernal chest pain and diaphoresis
d. Sudden, patchy blue mottling on feet and toes and rest pain
Priority nursing measures after an abdominal aortic aneurysm
repair include
a. assessment of cranial nerves and mental status.
b. administration of IV heparin and monitoring of aPTT.
c. administration of IV fluids and monitoring of kidney function.
d. elevation of the legs and application of elastic compression
stockings
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*Correct answer: c*
Rationale: Significant risk factors for peripheral artery disease
include tobacco use, hyperlipidemia, elevated levels of high-sen-
sitivity C-reactive protein, diabetes mellitus, and uncontrolled hy-
pertension; the most important is tobacco use. Other risk fac-
tors include family history, hypertriglyceridemia, hyperuricemia,
increasing age, obesity, sedentary lifestyle, and stress.
*Correct answer: c*
Rationale: Rest pain most often occurs in the forefoot or toes and
is aggravated by limb elevation. Rest pain occurs when blood flow
is insufficient to meet basic metabolic requirements of the distal
tissues. Rest pain occurs more often at night because cardiac
output tends to drop during sleep and the limbs are at the level
of the heart. Patients often try to achieve partial pain relief by
dangling the leg over the side of the bed or sleeping in a chair to
allow gravity to maximize blood flow.
*Correct answer: c*
Rationale: The patient has potentially developed acute arteri-
al ischemia (sudden interruption in the arterial blood supply to
the extremity), caused by an embolism from a cardiac thrombus
that occurred as a complication of infective endocarditis. Clinical
manifestations of acute arterial ischemia include any or all of
the six Ps : pain, pallor, paralysis, pulselessness, paresthesia,
and poikilothermia. Without immediate intervention, ischemia may
progress quickly to tissue necrosis and gangrene within a few
hours. If the nurse detects these signs, the physician should be
notified immediately.
*Correct answers: b, c, d*
Rationale: Both Buerger's disease and Raynaud's phenomenon
have the following clinical manifestations in common: cold sen-
sitivity, ischemic and gangrenous ulcers on fingertips, and color
changes of the distal extremity (fingers or toes).
*Correct answer: b*
Rationale: The clinical manifestations of a ruptured abdominal
aortic aneurysm include severe back pain, back or flank ecchy-
mosis (Grey Turner's sign), and hypovolemic shock (tachycardia,
hypotension, pale clammy skin, decreased urine output, altered
level of consciousness, and abdominal tenderness).
*Correct answer: c*
Rationale: Postoperative priorities include administration of IV flu-
ids and maintenance of renal perfusion. An adequate blood pres-
sure is important for maintaining graft patency, and administration
of IV fluids and blood components (as indicated) is essential for
adequate blood flow. The nurse should evaluate renal function by
measuring hourly urine output and monitoring daily blood urea
nitrogen (BUN) and serum creatinine levels. Irreversible renal
failure may occur after aortic surgery, particularly in individuals at
high risk.
 Ch. 38: Peripheral Vascular Disease NCLEX Questions
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The first priority of collaborative care of a patient with a suspected
acute aortic dissection is to
a. reduce anxiety.
b. control blood pressure.
c. monitor for chest pain.
d. increase myocardial contractility.
The patient at highest risk for venous thromboembolism (VTE) is
a. a 62-year-old man with spider veins who is having arthroscopic
knee surgery.
b. a 32-year-old woman who smokes, takes oral contraceptives,
and is planning a trip to Europe.
c. a 26-year-old woman who is 3 days postpartum and received
maintenance IV fluids for 12 hours during her labor.
d. an active 72-year-old man at home recovering from
transurethral
resection of the prostate for benign prostatic hyperplasia.
Which are probable clinical findings in a person with an acute
lower extremity VTE (select all that apply)?
a. Pallor and coolness of foot and calf
b. Mild to moderate calf pain and tenderness
c. Grossly diminished or absent pedal pulses
d. Unilateral edema and induration of the thigh
e. Palpable cord along a superficial varicose vein
The recommended treatment for an initial VTE in an otherwise
healthy person with no significant co-morbidities would include
a. IV argatroban (Acova) as an inpatient.
b. IV unfractionated heparin as an inpatient.
c. subcutaneous unfractionated heparin as an outpatient.
d. subcutaneous low-molecular-weight heparin as an outpatient.
A key aspect of teaching for the patient on anticoagulant therapy
includes which instructions?
a. Monitor for and report any signs of bleeding.
b. Do not take acetaminophen (Tylenol) for a headache.
c. Decrease your dietary intake of foods containing vitamin K.
d. Arrange to have blood drawn routinely to check drug levels.
In planning care and patient teaching for the patient with venous
leg ulcers, the nurse recognizes that the most important interven-
tion
in healing and control of this condition is
a. sclerotherapy.
b. using moist environment dressings.
c. taking horse chestnut seed extract daily.
d. applying elastic compression stockings.
A nurse is caring for a patient with a diagnosis of deep venous
thrombosis (DVT). The patient has an order to receive 30 mg
enoxaparin (Lovenox). Which injection site should the nurse use
to administer this medication safely?
a. Buttock, upper outer quadrant
b. Abdomen, anterior-lateral aspect
c. Back of the arm, 2 inches away from a mole
d. Anterolateral thigh, with no scar tissue nearby
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*Correct answer: b*
Rationale: The initial goals of therapy for acute aortic dissection
without complications are blood pressure (BP) control and pain
management. BP control reduces stress on the aortic wall by
reducing systolic BP and myocardial contractility.
*Correct answer: b*
Rationale: Three important factors (called Virchow's triad) in the
etiology of venous thrombosis are (1) venous stasis, (2) damage of
the endothelium (inner lining of the vein), and (3) hypercoagulabil-
ity of the blood. Patients at risk for venous thrombosis usually have
predisposing conditions for these three disorders (see Table 38-8).
The 32-year-old woman has the highest risk: long trips without
adequate exercise (venous stasis), tobacco use, and use of oral
contraceptives. Note: The likelihood of hypercoagulability of blood
is increased in women older than 35 years who use tobacco.
*Correct answers: b, d*
Rationale: The patient with lower extremity venous thromboem-
bolism (VTE) may or may not have unilateral leg edema, extremity
pain, a sense of fullness in the thigh or calf, paresthesias, warm
skin, erythema, or a systemic temperature greater than 100.4 F
(38 C). If the calf is involved, it may be tender to palpation.
*Correct answer: d*
Rationale: Patients with confirmed VTE should receive initial treat-
ment with low-molecular-weight heparin (LMWH), unfractionated
heparin (UH), fondaparinux, or rivaroxaban, followed by warfarin
for 3 months to maintain the international normalized ratio (INR)
between 2.0 and 3.0 for 24 hours. Patients with multiple comorbid
conditions, complex medical issues, or a very large VTE usually
are hospitalized for treatment and typically receive intravenous
UH. LMWH only for 3 months is another option for patients with
acute VTE. Depending on the clinical presentation, patients often
can be managed safely and effectively as outpatients.
*Correct answer: a*
Rationale: Patients taking anticoagulants should be taught to
monitor and report any signs of bleeding, which can be a serious
complication. Other important patient teaching includes main-
tenance of a consistent intake of foods containing vitamin K,
avoidance of supplements that contain vitamin K, and routine
coagulation laboratory studies if a patient is taking warfarin.
*Correct answer: d*
Rationale: Compression is essential for treating chronic venous
insufficiency (CVI), healing venous ulcers, and preventing ulcer
recurrence. Use of custom-fitted elastic compression stockings is
one option for compression therapy.
*Correct Answer: b*
Rationale: Enoxaparin (Lovenox) is a low-molecular-weight (LMW)
heparin that is given as a deep subcutaneous injection in the
right and left anterolateral abdomen. All subcutaneous injections
should be given away from scars, lesions, or moles.
 Ch. 38: Peripheral Vascular Disease NCLEX Questions
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The nurse is preparing to administer a scheduled dose of enoxa-
parin (Lovenox) 30 mg subcutaneously. What should the nurse do
*Correct Answer: D*
to administer this medication correctly?
Rationale: The nurse should gather together or "bunch up" the skin
a. Remove the air bubble in the prefilled syringe.
between the thumb and the forefinger before inserting the needle
b. Aspirate before injection to prevent IV administration.
into the subcutaneous tissue. The nurse should not remove the
c. Rub the injection site after administration to enhance absorp-
air bubble in the prefilled syringe, aspirate, nor rub the site after
tion.
injection.
d. Pinch the skin between the thumb and forefinger before insert-
ing the needle
The nurse is admitting a 68-year-old preoperative patient with
a suspected abdominal aortic aneurysm (AAA). The medica-
tion history reveals that the patient has been taking warfarin
*Correct Answer: A*
(Coumadin) on a daily basis. Based on this history and the pa-
tient's admission diagnosis, the nurse should prepare to admin-
Coumadin is a Vitamin K antagonist anticoagulant that could
ister which medication?
cause excessive bleeding during surgery if clotting times are not
corrected before surgery. For this reason, vitamin K is given as the
a. Vitamin K
antidote for warfarin (Coumadin).
b. Cobalamin
c. Heparin sodium
d. Protamine sulfate
The nurse is caring for a patient who has been receiving war-
farin (Coumadin) and digoxin (Lanoxin) as treatment for atrial
*Correct Answer: C*
fibrillation. Because the warfarin has been discontinued before
surgery, the nurse should diligently assess the patient for which
Rationale: Warfarin is an anticoagulant that is used to prevent
complication early in the postoperative period until the medication
thrombi from forming on the walls of the atria during atrial fibrilla-
is resumed?
tion. Once the medication is terminated, thrombi could again form.
If one or more thrombi detach from the atrial wall, they could travel
a. Decreased cardiac output
as cerebral emboli from the left atrium or pulmonary emboli from
b. Increased blood pressure
the right atrium.
c. Cerebral or pulmonary emboli
d. Excessive bleeding from incision or IV sites
The nurse is reviewing the laboratory test results for a 68-year-old
patient whose warfarin (Coumadin) therapy was terminated during
the preoperative period. The nurse concludes that the patient is Correct Answer: A
in the most stable condition for surgery after noting which INR
(international normalized ratio) result? Rationale: The therapeutic range for INR is 2.0 to 3.0 for many clin-
ical diagnoses. The larger the INR number, the greater the amount
a. 1.0 of anticoagulation. For this reason, the safest value before surgery
b. 1.8 is 1.0, meaning that the anticoagulation has been reversed.
c. 2.7
d. 3.4
The nurse would determine that a postoperative patient is not re-
*Correct Answer: C*
ceiving the beneficial effects of enoxaparin (Lovenox) after noting
what during a routine shift assessment?
Rationale: Enoxaparin is a low-molecular-weight heparin used to
prevent the development of deep vein thromboses (DVTs) in the
a. Generalized weakness and fatigue
postoperative period. Pain and swelling in the lower extremity can
b. Crackles bilaterally in the lung bases
indicate development of DVT and therefore may signal ineffective
c. Pain and swelling in lower extremity
medication therapy.
d. Abdominal pain with decreased bowel sounds

The nurse is caring for a patient with a recent history of deep

*Correct Answer: D*
vein thrombosis (DVT). The patient now needs to undergo surgery
for appendicitis. The nurse is reviewing the laboratory results for
Rationale: itamin K is the antidote to warfarin (Coumadin), which
this patient before administering an ordered dose of vitamin K.
the patient has most likely been taking before admission for treat-
The nurse determines that the medication is both safe to give and
ment of DVT. Warfarin is an anticoagulant that impairs the ability of
is most needed when the international normalized ratio (INR) is
the blood to clot. Therefore it is necessary to give vitamin K before
which result?
surgery to reduce the risk of hemorrhage. The largest value of the
INR indicates the greatest impairment of clotting ability, making
a. 1.0
2.2 the correct selection.
b. 1.2

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 Ch. 38: Peripheral Vascular Disease NCLEX Questions
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c. 1.6
d. 2.2
A postoperative patient asks the nurse why the physician ordered
daily administration of enoxaparin (Lovenox). Which reply by the
nurse is most appropriate?

a. "This medication will help prevent breathing problems after

*Correct Answer: C*
surgery, such as pneumonia."
b. "This medication will help lower your blood pressure to a safer
Enoxaparin is an anticoagulant that is used to prevent DVTs
level, which is very important after surgery."
postoperatively. All other explanations/options do not describe the
c. "This medication will help prevent blood clots from forming in
action/purpose of enoxaparin.
your legs until your level of activity, such as walking, returns to
normal."
d. "This medication is a narcotic pain medication that will help take
away any muscle aches caused by positioning on the operating
room table."
The nurse is caring for a preoperative patient who has an order
for vitamin K by subcutaneous injection. The nurse should verify *Correct Answer: C*
that which laboratory study is abnormal before administering the
dose? Rationale: Vitamin K counteracts hypoprothrombinemia and/or re-
verses the effects of warfarin (Coumadin) and thus decreases the
a. Hematocrit (Hct) risk of bleeding. High values for either the prothrombin time (PT)
b. Hemoglobin (Hgb) or the international normalized ratio (INR) demonstrates the need
c. Prothrombin time (PT) for this medication.
d. Partial thromboplastin time (PTT)
The nurse is caring for a newly admitted patient with vascular in-
sufficiency. The patient has a new order for enoxaparin (Lovenox)
*Correct Answer: B*
30 mg subcutaneously. What should the nurse do to correctly
administer this medication?
Rationale: The nurse should not expel the air bubble from the
prefilled syringe because it should be injected to clear the needle
a. Spread the skin before inserting the needle.
of medication and avoid leaving medication in the needle track in
b. Leave the air bubble in the prefilled syringe.
the tissue.
c. Use the back of the arm as the preferred site.
d. Sit the patient at a 30-degree angle before administration.
What is a priority nursing intervention in the care of a patient with *Correct Answer: D*
a diagnosis of chronic venous insufficiency (CVI)?
CVI requires conscientious and consistent application of com-
a. Application of topical antibiotics to venous ulcers pression stockings. Anticoagulants are not necessarily indicated
b. Maintaining the patient's legs in a dependent position and antibiotics, if required, are typically oral or IV, not topical.
c. Administration of oral and/or subcutaneous anticoagulants The patient should avoid prolonged positioning with the limb in a
d. Teaching the patient the correct use of compression stockings dependent position.
A patient with varicose veins has been prescribed compression
stockings. How should the nurse teach the patient to use these?
*Correct Answer: B*
a. "Try to keep your stockings on 24 hours a day, as much as
possible." Rationale: The patient with varicose veins should apply stockings
b. "While you're still lying in bed in the morning, put on your in bed, before rising in the morning. Stockings should not be worn
stockings." continuously, but they should not be removed several times daily.
c. "Dangle your feet at your bedside for 5 minutes before putting Dangling at the bedside prior to application is likely to decrease
on your stockings." their effectiveness.
d. "Your stockings will be most effective if you can remove them
for a few minutes several times a day."
Assessment of a patient's peripheral IV site reveals that phlebitis
has developed over the past several hours. Which intervention *Correct Answer: A*
should the nurse implement first?
Rationale: The priority intervention for superficial phlebitis is re-
a. Remove the patient's IV catheter. Correct moval of the offending IV catheter. Decreasing the IV rate is
b. Apply an ice pack to the affected area. insufficient. Anticoagulants are not normally required, and warm,
c. Decrease the IV rate to 20 to 30 mL/hr. moist heat is often therapeutic.
d. Administer prophylactic anticoagulants.

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 Ch. 38: Peripheral Vascular Disease NCLEX Questions
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A 62-year-old Hispanic male patient with diabetes mellitus has
*Correct Answer: B*
been diagnosed with peripheral artery disease (PAD). The patient
is a smoker and has a history of gout. What should the nurse focus
Rationale: Smoking is the most significant factor for this patient.
her teaching on to prevent complications for this patient?
PAD is a marker of advanced systemic atherosclerosis. Therefore
tobacco cessation is essential to reduce PAD progression, CVD
a Gender
events, and mortality. Diabetes mellitus and hyperuricemia are
b Smoking
also risk factors. Being male or Hispanic are not risk factors for
c Ethnicity
PAD.
d Co-morbidities
What medications should the nurse expect to include in the teach- *Correct Answers: a, c, d*
ing plan to decrease the risk of cardiovascular events and death
for PAD patients (select all that apply)? Angiotensin-converting enzyme inhibitors (e.g., ramipril [Altace])
are used to control hypertension. Statins (e.g., simvastatin [Zocor])
a Ramipril (Altace) are used for lipid management. Aspirin is used as an antiplatelet
b Cilostazol (Pletal) agent. Cilostazol (Pletal) is used for intermittent claudication, but
c Simvastatin (Zocor) it does not reduce CVD morbidity and mortality risks. Clopidogrel
d Clopidogrel (Plavix) may be used if the patient cannot tolerate aspirin. Anticoagulants
e Warfarin (Coumadin) (e.g., warfarin [Coumadin]) are not recommended to prevent CVD
f Aspirin (acetylsalicylic acid) events in PAD patients.
A female patient with critical limb ischemia has had peripheral
*Correct Answer: B*
artery bypass surgery to improve her circulation. What care should
the nurse provide on postoperative day 1?
Rationale: To avoid blockage of the graft or stent, the patient
should walk several times on postoperative day 1 and subsequent
a Keep the patient on bed rest.
days. Having the patient's knees flexed for sitting in a chair or in
b Assist the patient with walking several times.
bed increase the risk of venous thrombosis and may place stress
c Have the patient sit in the chair several times.
on the suture lines.
d Place the patient on her side with knees flexed.
*Correct Answer: B*
A patient was just diagnosed with acute arterial ischemia in the
left leg secondary to atrial fibrillation. Which early clinical mani- Rationale:
festation must be reported to the physician immediately to save
the patient's limb? The physician must be notified immediately if any of the six Ps
of acute arterial ischemia occur to prevent ischemia from quickly
a Paralysis progressing to tissue necrosis and gangrene. The six Ps are
b Paresthesia paresthesia, pain, pallor, pulselessness, and poikilothermia, with
c Crampiness paralysis being a very late sign indicating the death of nerves to
d Referred pain the extremity. Crampy leg sensation is more common with varicose
veins. The pain is not referred.
*Correct Answer: A*

Rationale: Buerger's disease is a nonatherosclerotic, segmental,

A 40-year-old man tells the nurse he has a diagnosis for the
recurrent inflammatory disorder of small and medium-sized veins
color and temperature changes of his limbs but can't remember
and arteries of upper and lower extremities leading to color and
the name of it. He says he must stop smoking and avoid trauma
temperature changes of the limbs, intermittent claudication, rest
and exposure of his limbs to cold temperatures to get better. This
pain, and ischemic ulcerations. It primarily occurs in men younger
description should allow the nurse to ask the patient if he has
than 45 years old with a long history of tobacco and/or marijuana
which diagnosis?
use. Buerger's disease treatment includes smoking cessation,
trauma and cold temperature avoidance, and a walking program.
a Buerger's disease
Venous thrombosis is the formation of a thrombus in association
b Venous thrombosis
with inflammation of the vein. Acute arterial ischemia is a sudden
c Acute arterial ischemia
interruption in arterial blood flow to a tissue caused by embolism,
d Raynaud's phenomenon
thrombosis, or trauma. Raynaud's phenomenon is characterized
by vasospasm-induced color changes of the fingers, toes, ears,
and nose.
*Correct Answer: D*
A male patient was admitted for a possible ruptured aortic
aneurysm, but had no back pain. Ten minutes later his assessment
Rationale: The lack of back pain indicates the patient is most
includes the following: sinus tachycardia at 138, BP palpable at 65
likely exsanguinating into the abdominal space, and the bleeding
mm Hg, increasing waist circumference, and no urine output. How
is likely to continue without surgical repair. A blockade of the blood
should the nurse interpret this assessment about the patient's
flow will not occur in the abdominal space as it would in the
aneurysm?
retroperitoneal space where surrounding anatomic structures may
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 Ch. 38: Peripheral Vascular Disease NCLEX Questions
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control the bleeding. The lack of urine output does not indicate
a Tamponade will soon occur. renal artery involvement, but that the bleeding is occurring above
b The renal arteries are involved. the renal arteries, which decreases the blood flow to the kidneys.
c Perfusion to the legs is impaired. There is no assessment data indicating decreased perfusion to
d He is bleeding into the abdomen. the legs.
*Correct Answer: B*
The patient had aortic aneurysm repair. What priority nursing
action will the nurse use to maintain graft patency? Rationale: The priority is to maintain an adequate BP (determined
by the surgeon) to maintain graft patency. A prolonged low BP
a Assess output for renal dysfunction. may result in graft thrombosis, and hypertension may cause undue
b Use IV fluids to maintain adequate BP. stress on arterial anastomoses resulting in leakage of blood or
c Use oral antihypertensives to maintain cardiac output. rupture at the suture lines, which is when IV antihypertensives may
d Maintain a low BP to prevent pressure on surgical site be used. Renal output will be assessed when the aneurysm repair
is above the renal arteries to assess graft patency, not maintain it.
When the patient is being examined for venous thromboembolism *Correct Answer: A*
(VTE) in the calf, what diagnostic test should the nurse expect to
teach the patient about first? Rationale: The duplex ultrasound is the most widely used test to
diagnose VTE. Contrast venography is rarely used now. Magnetic
a Duplex ultrasound resonance venography is less accurate for calf veins than pelvic
b Contrast venography and proximal veins. Computed tomography venography may be
c Magnetic resonance venography used but is invasive and much more expensive than the duplex
d Computed tomography venography ultrasound.
The patient reports tenderness when she touches her leg over a
*Correct Answer: D*
vein. The nurse assesses warmth and a palpable cord in the area.
The nurse knows the patient needs treatment to prevent which
Rationale: The clinical manifestations are characteristic of a su-
sequelae?
perficial vein thrombosis. If untreated, the clot may extend to
deeper veins, and venous thromboembolism may occur. Pul-
a Pulmonary embolism b Pulmonary hypertension
monary embolism, pulmonary hypertension, and post-thrombotic
c Post-thrombotic syndrome
syndrome are the sequelae of venous thromboembolism.
d Venous thromboembolism
The patient has CVI and a venous ulcer. The unlicensed as- *Correct Answer: A*
sistive personnel (UAP) decides to apply compression stockings
because that is what these patients always have ordered. What Rationale: Rest pain occurs as peripheral artery disease (PAD)
assessment by the nurse would cause the application of com- progresses and involves multiple arterial segments. Compression
pression stockings to harm the patient? stockings should not be used on patients with PAD. Elevated blood
glucose, possibly indicating uncontrolled diabetes mellitus, and
a Rest pain hypertension may or may not indicate arterial problems. Dry, itchy,
b High blood pressure flaky skin indicates venous insufficiency. The RN should be the
c Elevated blood sugar one to obtain the order and instruct the UAP to apply compression
d Dry, itchy, flaky skin stockings if they are ordered.
Which person should the nurse identify as having the highest risk
for abdominal aortic aneurysm? *Correct Answer: A*

a A 70-year-old male, with high cholesterol and hypertension The most common etiology of descending abdominal aortic
Correct aneurysm (AAA) is atherosclerosis. Male gender, age 65 years
b A 40-year-old female with obesity and metabolic syndrome or older, and tobacco use are the major risk factors for AAAs of
c A 60-year-old male with renal insufficiency who is physically atherosclerotic origin. Other risk factors include the presence of
inactive coronary or peripheral artery disease, high blood pressure, and
d A 65-year-old female with hyperhomocysteinemia and sub- high cholesterol.
stance abuse
A 67-year-old man with peripheral artery disease is seen in the
*Correct Answer: B*
primary care clinic. Which symptom reported by the patient would
indicate to the nurse that the patient is experiencing intermittent
Intermittent claudication is an ischemic muscle ache or pain that
claudication?
is precipitated by a consistent level of exercise, resolves within 10
minutes or less with rest, and is reproducible. Angina is the term
a Patient complains of chest pain with strenuous activity.
used to describe chest pain with exertion. Paresthesia is the term
b Patient says muscle leg pain occurs with continued exercise.
used to describe numbness or tingling in the toes or feet. Reactive
c Patient has numbness and tingling of all his toes and both feet.
hyperemia is the term used to describe redness of the foot; if the
d Patient states the feet become red if he puts them in a dependent
limb is in a dependent position the term is dependent rubor.
position.

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 Ch. 38: Peripheral Vascular Disease NCLEX Questions
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*Correct Answer: C*

A 32-year-old female is prescribed diltiazem (Cardizem) for Ray- Raynaud's phenomenon is an episodic vasospastic disorder of
naud's phenomenon. To evaluate the patient's expected response small cutaneous arteries, most frequently involving the fingers
to this medication, what is most important for the nurse to assess? and toes. Diltiazem (Cardizem) is a calcium channel blocker that
relaxes smooth muscles of the arterioles by blocking the influx of
a Improved skin turgor calcium into the cells, thus reducing the frequency and severity
b Decreased cardiac rate of vasospastic attacks. Perfusion to the fingertips is improved and
c Improved finger perfusion vasospastic attacks reduced. Diltiazem may decrease heart rate
d Decreased mean arterial pressure and blood pressure, but that is not the purpose in Raynaud's
phenomenon. Skin turgor is most often a reflection of hydration
status.
A 39-year-old woman with a history of smoking and oral con-
traceptive use is admitted with a venous thromboembolism
*Correct Answer: D*
(VTE) and prescribed unfractionated heparin. What laboratory test
should the nurse review to evaluate the expected effect of the
Unfractionated heparin can be given by continuous IV for VTE
heparin?
treatment. When given IV, heparin requires frequent laboratory
monitoring of clotting status as measured by activated partial
a Platelet count
thromboplastin time (aPTT). Platelet counts can decrease as an
b Activated clotting time (ACT)
adverse reaction to heparin, but that is not the expected effect.
c International normalized ratio (INR)
d Activated partial thromboplastin time (APTT)
*Correct Answer: B*

A 73-year-old man with dementia has a venous ulcer related to A patient with a venous ulcer should have a balanced diet with
chronic venous insufficiency. The nurse should provide education adequate protein, calories, and micronutrients; this type of diet is
on which type of diet for this patient and his caregiver? essential for healing. Nutrients most important for healing include
protein, vitamins A and C, and zinc. Foods high in protein (e.g.,
a Low-fat diet meat, beans, cheese, tofu), vitamin A (green leafy vegetables),
b High-protein diet vitamin C (citrus fruits, tomatoes, cantaloupe), and zinc (meat,
c Calorie-restricted diet seafood) must be provided. Restricting fat or calories is not helpful
d High-carbohydrate diet for wound healing or in patients of normal weight. For overweight
individuals with no active venous ulcer, a weight-loss diet should
be considered.

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