Chapter 26: Drugs Used to Treat Peripheral Vascular Disease My Nursing Test Banks

Chapter 26: Drugs Used to Treat Peripheral Vascular Disease

Test Bank

MULTIPLE CHOICE

1. The nurse is assessing the patients leg for peripheral vascular disease (PVD) and is unable to palpate the pedal pulse in either foot. Which action will the nurse take first?

a.

Contact the health care provider for further orders.

b.

Request x-ray studies of the lower extremities.

c.

Request that the patient lie flat.

d.

Obtain a Doppler ultrasound device for auscultation.

ANS: D

The Doppler ultrasound device may aid in determining peripheral blood flow. This is not a sufficient cause to notify the health care provider and does not warrant radiologic examination without further assessment. Positioning will not affect the assessment of pedal pulses.

DIF: Cognitive Level: Application REF: p. 418 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

2. What is the action of pentoxifylline (Trental), a hemorheologic agent used to treat chronic occlusive arteriole disease?

a.

Vasodilates the peripheral arteries

b.

Potentiates the blood clotting mechanism

c.

Increases erythrocyte flexibility

d.

Increases blood viscosity

ANS: C

Pentoxifylline enhances red blood cell (erythrocyte) flexibility, which reduces blood viscosity. This allows for more blood to perfuse into the tissues. Muscle tissues become better oxygenated and intermittent claudication is reduced. Pentoxifylline does not cause vasodilation. Pentoxifylline acts to decrease clotting and decreases blood viscosity.

DIF: Cognitive Level: Comprehension REF: p. 420 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. Which assessment verifies increased blood perfusion to the lower extremities?

a.

Toes cool to the touch

b.

Decreased sensation below the knees

c.

Increased amplitude of pedal pulses

d.

Paleness of the foot

ANS: C

The pressure of blood as it is pushed against an artery is detected as a pulse. Increased pulse amplitude indicates increased blood flow. Coolness and decreased sensation usually correlate with decreased blood perfusion. Paleness or blanching does not indicate increased blood perfusion.

DIF: Cognitive Level: Comprehension REF: p. 420 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which patient statement indicates to the nurse that the patient has a good understanding of PVD?

a.

Symptoms are warning signs of the increased potential to develop diseases.

b.

Pharmacologic treatments can reverse the disease process.

c.

Surgical interventions will cure the disease.

d.

Controlling contributing factors may affect the progression of the disease.

ANS: D

Patients must be taught the interrelationships between the PVD and other related diseases that they may have, such as diabetes, hypertension, angina, and hyperlipidemia. Control or lack of control of the contributing factors of these related diseases will significantly affect the progression of the PVD. PVD is usually a development that is related to other diseases already present in the body. PVD can be controlled but not cured or completely reversed. Surgical interventions will not cure the disease, although it may somewhat control the vascular damage.

DIF: Cognitive Level: Comprehension REF: pp. 416-417 OBJ: 4 | 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

5. The nurse is assessing a patient on papaverine therapy and notes tachycardia, which is a compensatory effect of which condition?

a.

Hypoventilation

b.

Hypotension

c.

Excessive sympathetic stimulation

d.

Adrenergic suppression

ANS: B

An adverse effect of papaverine therapy is hypotension. When blood pressure drops, cardiac output decreases, and there is less available oxygenated blood flowing to the periphery. Baroreceptors trigger the heart to increase the rate, which causes tachycardia to maintain cardiac output and the perfusion of oxygenated blood to the tissues. Tachycardia is not compensatory for hypoventilation, sympathetic stimulation, or adrenergic suppression.

DIF: Cognitive Level: Application REF: p. 421 OBJ: 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

6. When assessing a client recently prescribed pentoxifylline (Trental), which medication will alert the nurse to monitor closely for adverse effects?

a.

Antilipemic

b.

Antihypertensive

c.

Antibiotic

d.

Antipsychotic

ANS: B

Patients receiving pentoxifylline frequently display a small reduction in systemic blood pressure. An antihypertensive medication may potentiate this effect. Patients must be monitored for hypotension, and therapy may have to be reduced to minimize adverse effects. Pentoxifylline does not interact with antilipemic, antibiotic, or antipsychotic agents.

DIF: Cognitive Level: Application REF: p. 421 OBJ: 4 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

7. The nurse advises a patient taking papaverine to consult the health care provider or pharmacist before taking which over the counter (OTC) medication?

a.

Laxatives

b.

Cough and cold remedies

c.

Vitamin supplements

d.

Acetaminophen

ANS: B

OTC cough and cold preparations may counteract the effects of papaverine. Laxatives, vitamin supplements, and acetaminophen do not interact with papaverine.

DIF: Cognitive Level: Comprehension REF: pp. 421-422 OBJ: 4 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. A patient has recently been prescribed cilostazol (Pletal). Which statement by the patient indicates that this medication is effective?

a.

I have less leg cramping when I walk.

b.

My pulse rate is more regular.

c.

I have had fewer episodes of angina.

d.

My blood pressure has decreased.

ANS: A

The primary therapeutic outcome expected from cilostazol is improved tissue perfusion, with a reduced frequency of pain, improved tolerance to exercise, and improved peripheral pulses. A more regular pulse, decreased episodes of angina, and decreased blood pressure are not expected outcomes of cilostazol administration.

DIF: Cognitive Level: Application REF: p. 422 OBJ: 4 | 7

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. The nurse has completed teaching to a patient recently prescribed cilostazol (Pletal). Which statement by the patient indicates a need for further teaching?

a.

I will sit down if I feel lightheaded or faint.

b.

Because this medication helps my circulation, I will try to quit smoking.

c.

Grapefruit juice will increase the effects of this medication.

d.

Diarrhea may occur but likely will stop with continued therapy.

ANS: C

Grapefruit juice inhibits the metabolism of cilostazol and would decrease the effects of the medication. Sitting down when feeling lightheaded is an appropriate patient action. Smoking may limit the benefits of taking cilostazol. Diarrhea is usually mild and tends to resolve with continued therapy.

DIF: Cognitive Level: Application REF: p. 422 OBJ: 7

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. The nurse observes a patient taking papaverine hydrochloride to be flushed and diaphoretic following the initial dose. The nurses best response is to:

a.

hold the next dose.

b.

assess blood glucose.

c.

provide comfort measures.

d.

immediately notify the physician.

ANS: C

Flushing and sweating are considered common side effects of papaverine hydrochloride. Providing comfort measures is the best response after the initial dose. It is not necessary to hold the next dose. Assessing blood glucose is not indicated. It is not necessary to notify the physician at this time.

DIF: Cognitive Level: Application REF: p. 421 OBJ: 4 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

11. The nurse is preparing to provide personal care to a patient with peripheral vascular disease. When providing foot care, the nurse will:

a.

assist the patient to a supine position.

b.

keep feet moistened with lotion.

c.

trim toenails daily.

d.

change socks daily.

ANS: D

To avoid skin breakdown, the patient should change socks daily. Blood flow is improved when the head of the bed is elevated 12 to 16 inches. Supine position is contraindicated. Feet should be kept dry on a person with peripheral vascular disease. Toenails should be trimmed when necessary, preferably by a podiatrist.

DIF: Cognitive Level: Application REF: p. 419 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

MULTIPLE RESPONSE

12. Which are included in the baseline assessment of PVD? (Select all that apply.)

a.

History of heart disease

b.

Smoking and dietary habits

c.

Current medications

d.

Weight

e.

Limb pain

f.

Mental status

ANS: A, B, C, D, E

Age, gender, race, family history of incidence of symptoms of PVD, hypertension, and cardiac disease indicate risk factors for developing PVD. Smoking causes vasoconstriction, and dietary habits can cause atherosclerosis, predisposing the patient to PVD. Current medications are essential to know in order to prescribe a pharmacological agent without exposing the patient to possible drug interactions. Weight may factor into calculations for prescribing medications to treat PVD. Limb pain is a symptom of PVD and may allow the health care provider to assess the extent of existing disease. Mental status is not included in the baseline assessment of PVD.

DIF: Cognitive Level: Comprehension REF: p. 418 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

13. The nurse is preparing a teaching plan for a patient with Raynauds disease who is soon to be discharged. What information will be included to improve circulation and prevent complications of this disease? (Select all that apply.)

a.

Begin a daily exercise program.

b.

Keep hands and feet warm.

c.

Surgery is often the most effective treatment.

d.

Elevate the lower extremities when reclining.

e.

Smoking cessation will improve outcomes.

ANS: A, B, E

Daily exercise, maintenance of extremity warmth, and smoking cessation promote circulation and prevent complications. Surgery is not an effective treatment for Raynauds disease. Patients with Raynauds disease should not elevate their extremities when reclining.

DIF: Cognitive Level: Application REF: pp. 416-417 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

14. What will the nurse include in the discharge teaching plan for a patient with PVD? (Select all that apply.)

a.

Intermittent cold applications to the extremities

b.

Heat therapy

c.

Stress reduction techniques

d.

An exercise program

e.

Bed positioning techniques

ANS: C, D, E

Diseases such as diabetes, hypertension, angina, and hyperlipidemia are interrelated with PVD. Stress reduction techniques will assist patients in reducing blood pressure, smoking, and overeating. A daily exercise program can significantly improve collateral circulation. Bed positioning techniques, such as elevating the bed 12 to 16 inches, improve blood flow to the periphery. Intermittent cold applications to the extremities and heat therapy will not benefit the patient with PVD.

DIF: Cognitive Level: Application REF: pp. 416-417 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

15. Which are necessary steps in the assessment of the patient preparing for treatment PVD with pentoxifylline (Trental)? (Select all that apply.)

a.

Check for intolerance to caffeine.

b.

Obtain baseline data on pain that may be present.

c.

Obtain test results for PT and aPTT.

d.

Perform baseline gastrointestinal assessment to determine if the patient has nausea, vomiting, or dyspepsia.

e.

Ask specifically if the patient has any cardiac symptoms or dizziness.

f.

Schedule the patient for an exercise stress test.

ANS: A, B, D, E

Before beginning therapy with pentoxifylline, the nurse should determine intolerance to caffeine. To evaluate therapeutic effects of prescribed medications, a baseline is needed against which to compare future assessments. Before beginning therapy with pentoxifylline, the nurse should determine baseline gastrointestinal symptoms and assess for cardiac symptoms, pain, and dizziness. Bleeding times do not apply to therapy with this drug. Exercise stress testing is not part of the premedication assessment.

DIF: Cognitive Level: Application REF: pp. 420-421 OBJ: 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

16. The nurse has admitted a resident with the diagnosis of PVD to a long term care facility. When providing care to this patient, the nurse will: (Select all that apply.)

a.

initiate elevation of lower extremities.

b.

implement pain management as ordered.

c.

assess skin temperature.

d.

vigorously dry feet after washing.

e.

palpate pedal pulses.

ANS: B, C, E

Pain management, assessment of skin temperature, and palpation of pedal pulses are indicated with the care of a patient with PVD. The nurse needs to check with the health care provider before initiating elevation of the extremities. It is contraindicated in patients with arterial insufficiency. After bathing, feet should be gently dried. Vigorous rubbing is contraindicated.

DIF: Cognitive Level: Application REF: p. 419 OBJ: 1 | 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

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