Med-surge 2 practice questions

Question 1

Decreased perfusion to the peripheral tissues

Answer 1

ischemia

Question 2

Key part of management

Answer 2

Education

Question 3

Proper nutrition, smoking cessation, & exercise are important

Answer 3

health promotion behaviors

Question 4

Ischemic muscle pain caused by a constant level of exercise (buildup of lactic acid from anaerobic metabolism), • Resolves within 10 minutes or less with rest, and Reproducible

Answer 4

Intermittent claudication (classic symptom)

Question 5

Numbness or tingling in toes or feet from nerve tissue ischemia; Neuropathy causes severe shooting or burning pain; Produces loss of pressure and deep pain sensations from reduced blood flow; Injuries often go unnoticed by patient

Answer 5

Paresthesia

Question 6

Thin, shiny, taut skin; Loss of hair on lower legs; Diminished or absent pedal, popliteal, or femoral pulses; Pallor (blanching) of foot with leg elevation; Reactive hyperemia (redness) of foot develops with dependent position (dependent rubor)

Answer 6

Reduced blood flow to limb

Question 7

As disease progresses; Occurs in feet or toes; Aggravated by limb elevation; Occurs from insufficient blood flow to distal tissues; Occurs more often at night because cardiac output tends to drop during sleep & limbs are at level of the heart; Pain relief by gravity, dangling leg over side of bed or sleeping in a chair

Answer 7

Pain at rest

Question 8

is condition characterized by chronic ischemic rest pain lasting >2 weeks, nonhealing arterial leg ulcers, or gangrene of leg from PAD. Patients with PAD who have diabetes, HF, & HX of a stroke are at increased risk of CLI.

Answer 8

Critical limb ischemia (CLI)

Question 9

• Atrophy of skin and underlying muscles
• Delayed healing
• Wound infection
• Tissue Necrosis
• Arterial (ischemic) ulcers most often occur over bony prominences on toes, feet & lower legs
• Most serious: Nonhealing arterial ulcers and gangrene (collateral circulation may prevent gangrene)
• May result in amputation (If adequate blood flow is not restored & if severe infection occurs; Indicated with uncontrolled pain & spreading infection)
• Peripheral Arterial Disease of Lower Extremities: Diagnostic Studies and Tables 37-2, 37-3, and 31-7 in the textbook

Answer 9

Complications - Prolonged ischemia leads to:

Question 10

• Segmental BPs are obtained using Doppler ultrasound & a sphygmomanometer at the thigh, below the knee, & at ankle level while patient is supine.

Answer 10

A drop in segmental BP of >30 mm Hg suggests PAD.

Question 11

• Angiography & magnetic resonance angiography show the location & extend of:

Answer 11

PAD

Question 12

Reduce sodium; Dash Diet will:

Answer 12

Control BP

Question 13

Essential to reduce risk for CVD events, PAD progression, & death

Answer 13

Tobacco cessation

Question 14

Diabetes is major risk factor for PAD & increases risk for amputation

Answer 14

Hemoglobin A1C<7.0% for diabetics

Question 15

Statins (e.g., simvastatin [Zocor]) & a fibric acid derivative (gemfibrozil [Lopid])

Answer 15

Aggressive treatment of hyperlipidemia-diet and statins

Question 16

• Decreases cardiovascular morbidity; Decreases mortality; Increases peripheral blood flow; Increases ankle-brachial index (ABI); Increases walking distance

Answer 16

Ramipril (Altace)

Question 17

• Walking is most effective exercise for individuals with claudication; 30 to 45 minutes daily, 3 times/week
• Women have faster decline and mobility loss than men
• Daily exercise increases survival rates

Answer 17

Exercise therapy

Question 18

• BMI <25 kg/m2
• Waist circumference <40 inches for men and < 35 inches for women
• 3% to 5% weight loss yields reduced triglycerides, glucose, A1C, and decreased risk of type 2 diabetes
• Recommend reduced calories and salt for obese or overweight persons

Answer 18

Nutritional therapy

Question 19

Risk factors for a DVT are lower extremity orthopedic surgery, history of fracture, hypertension, immobility, advanced age, and obesity. Immobility, age, and obesity may allow for an incomplete blood flow return from the lower extremities. If blood is allowed to remain stagnant and not move, the possibility of a clot forming is increased. The surgery and history of fracture can place one at an increased risk for clot formation as the surgery location will result in less mobility.

Answer 19

risk factors for development of a DVT

Question 20

Blood in urine or stool; or black, tarry stools
Vomiting blood, coffee-grounds emesis
Unusual bleeding from gums, skin, or nose, or heavy menstrual bleeding
Severe headaches or stomach pain
Chest pain, SOB, palpitations (heart racing)
Weakness, dizziness, mental status changes
Cold, blue, or painful feet

Answer 20

Contact ERS immediately for any of the following adverse side effects of drug therapy