Arterial Insufficiency and Venous Insufficiency (15 Questions)

1. Mr. Arthur Dent, 72 years old, has severe Peripheral Arterial Disease (PAD). He tells the nurse, "I am exhausted. Every time I lie flat in bed to sleep, I wake up with burning pain in my toes and feet. The only thing that helps is getting up and walking around or sitting on the edge of the bed."

Question:
What is the most appropriate teaching the nurse should provide to help Mr. Dent sleep? *

"Try elevating your legs on two pillows to reduce the swelling and inflammation."

"Apply a heating pad directly to your feet to dilate the blood vessels before bed."

"Try sleeping in a recliner chair with your legs lowered, or sleep with your legs dangling off the side of the bed."

"Wear tight compression stockings to bed to improve blood flow return."

2. Ms. Clara Oswald, 55 years old, works as a cashier and stands for 8 hours a day. She is diagnosed with Chronic Venous Insufficiency. She complains, "My legs feel so heavy and achy at the end of the day, and they throb when I try to sleep." Assessment reveals 2+ pitting edema in the ankles.

Question:
What instruction should the nurse provide to alleviate her symptoms during sleep? *

"Sleep sitting up in a chair to prevent fluid from traveling to your lungs."

"Sleep with your legs raised on pillows above the level of your heart."

"Dangle your legs over the side of the bed to improve circulation."

"Avoid drinking water after 6:00 PM to reduce the amount of fluid in your legs."

3. The nurse is assessing a wound on the lower leg of Mr. Rory Williams, 68 years old. The wound is located on the medial malleolus (inner ankle). It has irregular borders, the wound base is beefy red with moderate exudate (wet), and the surrounding skin is brown and hardened.

Question:
Based on these findings, how should the nurse identify this wound? *

A Venous Stasis Ulcer.

An Arterial Ischemic Ulcer.

A Diabetic Neuropathic Ulcer.

A Pressure Injury (Stage 3).

4. Ms. Martha Jones, 60 years old, presents with bilateral leg edema and varicose veins. The physician orders the application of high-compression stockings (30-40 mmHg). Before applying the stockings, the nurse notes the patient’s feet are cool to the touch and the pedal pulses are non-palpable.

Question:
What is the priority nursing action? *

Apply the stockings immediately to warm the feet.

Encourage the patient to walk for 10 minutes, then apply the stockings.

Hold the application and request an Ankle-Brachial Index (ABI) assessment.

Document the cool skin and apply the stockings as ordered.

5. The nurse is performing a vascular assessment on Mr. Jack Harkness, 50 years old. When the patient lies flat and elevates his legs to 60 degrees, the soles of his feet turn pallid (white). When he sits up and dangles his legs over the edge of the bed, the feet turn a deep rubor (red/purple) color.

Question:
What is the clinical significance of these findings? *

Normal vascular response to position changes.

Severe Peripheral Arterial Disease (Dependent Rubor).

Severe Venous Insufficiency (Venous Stasis).

Deep Vein Thrombosis (DVT).

6. Mrs. Sarah Jane, 65 years old, is diagnosed with PAD. She reports, "I can't walk my dog anymore because my calf muscles cramp up after one block. It stops hurting when I rest, but I'm afraid to walk now."

Question:
What advice should the nurse give regarding exercise? *

"You should stop walking immediately to prevent muscle damage; switch to swimming."

"Walk until the pain starts, then immediately sit down and elevate your legs."

"Walk until the pain becomes moderate, stop and rest until it goes away, then resume walking."

"Push through the pain and do not stop; the pain means the muscles are getting stronger."

7. The nurse is admitting Mr. Wilfred Mott, 79 years old, for a femoral-popliteal bypass surgery. During the skin assessment of the lower extremities, which findings are consistent with his diagnosis of Arterial Insufficiency? *

Warm skin, brown pigmentation, and bounding pulses.

Hairy legs, mild edema, and cyanotic toes.

Shiny, hairless skin, thickened toenails, and cool temperature.

Red, hot, swollen calf with tenderness to touch.

8. Ms. Donna Noble, 58 years old, has PAD and complains that her feet are always freezing cold at night. She asks the nurse what she can do to warm them up.

Question:
Which suggestion is safe and appropriate? *

"Soak your feet in a basin of hot water for 20 minutes before bed."

"Use a heating pad set to 'low' wrapped around your feet."

"Wear loose-fitting, warm wool socks to bed."

"Place a hot water bottle at the foot of the bed."

9. Mr. Mickey Smith, 62 years old, returns to the unit following a right femoral-popliteal bypass graft. Two hours post-op, the nurse performs a neurovascular check. The right foot is pale, cool to the touch, and the dorsalis pedis pulse is no longer palpable (it was audible by Doppler 1 hour ago).

Question:
What is the nurse’s priority action? *

Document the findings and re-check in 30 minutes.

Apply a warm blanket to the right leg to induce vasodilation.

Notify the surgeon immediately.

Elevate the leg on pillows to reduce post-op swelling.

10. Mrs. Rose Tyler, 70 years old, has a large, weeping venous stasis ulcer on her ankle that has been slow to heal. The nurse is reviewing her dietary habits to promote wound healing.

Question:
Which dietary components should the nurse encourage Mrs. Tyler to increase? *

Carbohydrates and fats to provide energy.

Protein, Vitamin C, and Zinc.

Vitamin K and leafy greens.

Fluid restriction and low sodium.

11. Mr. George Hammond, 55 years old, is being discharged with a diagnosis of Peripheral Arterial Disease (PAD). The nurse is reviewing lifestyle modifications to prevent the progression of the disease and worsening of symptoms. Mr. Hammond asks, "I know I have to walk, but is there anything specific I should stay away from?"

Question:
Which instruction regarding "what to avoid" is the most important for the nurse to include? *

"Avoid swimming in heated pools, as heat causes veins to collapse."

"Avoid drinking more than 1 liter of water a day to prevent edema."

"Avoid exposure to cold temperatures and stop smoking immediately."

"Avoid eating leafy green vegetables because they thicken the blood."

12. Mrs. Samantha Carter, 62 years old, returns to the nursing unit following a Percutaneous Transluminal Angioplasty (PTA) with stenting of the right femoral artery. The procedure was performed via a catheter insertion in the right groin. She is alert and oriented.

Question:
What is the priority nursing intervention for the immediate post-operative period (first 4-6 hours)? *

Assist the patient to a high-Fowler’s position (90 degrees) to facilitate breathing.

Keep the right leg straight and flat; monitor the puncture site for hematoma or bleeding.

Encourage the patient to ambulate to the bathroom to prevent DVT.

Apply warm compresses to the groin to reduce insertion site pain.

13. Ms. Teal’c, 40 years old, underwent Vein Ligation and Stripping surgery on her right leg this morning to treat severe varicose veins. She is preparing for discharge.

Question:
Which discharge instruction is appropriate for this specific venous surgery? *

"Keep your leg strictly flat at all times for the next week."

"Remove the elastic compression bandages immediately when you get home to air out the incisions."

"Sit in a chair for at least 6 hours a day to rest the leg."

"Elevate your legs above heart level when lying down and walk for short periods every hour."

14. Mr. Daniel Jackson, 48 years old, had a femoral-popliteal bypass graft 12 hours ago. He calls the nurse complaining of excruciating pain in the operative leg that is not relieved by the prescribed IV morphine. Upon assessment, the leg feels tense (hard) and swollen, and he reports a "pins and needles" sensation.

Question:
What complication should the nurse suspect, and what is the required action? *

Compartment Syndrome; notify the surgeon immediately.

Graft Occlusion; apply a heating pad.

Deep Vein Thrombosis; administer Heparin.

Normal post-operative pain; re-administer morphine in 1 hour.

15. Mr. Jonas Quinn, 67 years old, has Peripheral Arterial Disease (PAD) and Hypertension. He has a bad head cold and asks the nurse if he can take an over-the-counter oral decongestant (like Pseudoephedrine) that his wife uses.

Question:
What is the nurse’s best response? *

"Yes, that is fine as long as you take it with food."

"It is better to take Aspirin for your cold symptoms."

"You should avoid oral decongestants because they constrict blood vessels and can raise your blood pressure and worsen your leg circulation."

"You can take it, but you must double your blood pressure medication dose while you are on it."