Welcome future RN and LPN nurses! As you gear up to conquer the NCLEX, understanding how to answer NCLEX questions on Peripheral Arterial Disease is paramount to ensuring your success. Let’s dive in.
Question 1: A 60-year-old patient presents with complaints of intermittent leg pain while walking that improves with rest. On assessment, the nurse notes diminished pedal pulses and shiny, hairless skin on the lower extremities. Which of the following assessments is most appropriate for confirming the presence of peripheral artery disease (PAD)?
A. Ankle-brachial index (ABI) measurement
B. Doppler ultrasound of lower extremities
D. Blood glucose monitoring
E. Capillary refill test
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Correct answer: A. Ankle-brachial index (ABI) measurement
Rationale: The vignette describes classic signs of PAD, such as intermittent claudication, diminished pedal pulses, and skin changes. The most appropriate assessment to confirm PAD is the ABI, which compares blood pressure in the arms to that in the legs. Doppler ultrasound and MRA may help visualize vascular changes, but the ABI is a direct measure of arterial circulation. Blood glucose monitoring and capillary refill test are unrelated to confirming PAD.
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Question 2: A patient with a history of diabetes mellitus and smoking presents with non-healing ulcers on the feet, decreased sensation, and weak pedal pulses. The nurse suspects peripheral artery disease (PAD) and should prioritize which intervention to improve arterial perfusion?
A. Administration of antiplatelet medication
B. Application of topical antibiotics
C. Referral for diabetic foot care education
D. Elevating the lower extremities
E. Initiating a smoking cessation program
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Correct answer: E. Initiating a smoking cessation program
Rationale: In this scenario, addressing the modifiable risk factors for PAD, particularly smoking cessation, is paramount to improve arterial perfusion. Smoking is a significant risk factor for PAD and cessation can halt disease progression. Antiplatelet medication, antibiotics, foot care education, and elevation may be important but addressing smoking cessation takes precedence in this case.
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Question 3: A patient with a diagnosis of peripheral artery disease (PAD) reports worsening pain in the lower extremities, even at rest. On examination, the nurse notes cool, pale extremities with absent pedal pulses. The nurse should recognize these findings as indicative of:
A. Stage I PAD
B. Stage II PAD
C. Stage III PAD
D. Stage IV PAD
E. Stage V PAD
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Correct answer: D. Stage IV PAD
Rationale: The description of worsening pain at rest, along with absent pedal pulses and severe skin changes (cool and pale extremities), aligns with Stage IV PAD according to the Rutherford classification. In this stage, critical limb ischemia is present, indicating severe arterial insufficiency with rest pain. Stages I, II, III, and V do not specifically encompass these severe symptoms of critical limb ischemia observed in Stage IV PAD.
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Question 4: A 68-year-old patient presents with complaints of leg pain while walking that subsides with rest. Upon examination, the nurse notices decreased hair growth on the legs, shiny skin, and diminished pedal pulses. Which diagnostic test is most appropriate for confirming peripheral artery disease (PAD)?
A. Encouraging increased dietary fat intake
B. Initiating a sedentary lifestyle
C. Administering vasoconstricting medications
D. Encouraging smoking cessation
E. Promoting high-impact exercises
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Correct answer: D. Encouraging smoking cessation
Rationale: Smoking is a major risk factor for PAD. Encouraging smoking cessation is crucial in managing PAD to prevent disease progression and improve arterial perfusion. Dietary changes, sedentary lifestyle, vasoconstricting medications, and high-impact exercises are not recommended and may exacerbate the condition.
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Question 5: Vignette: A patient diagnosed with PAD is undergoing treatment. Which intervention is crucial in the management of this condition?
A. Encouraging increased dietary fat intake
B. Initiating a sedentary lifestyle
C. Administering vasoconstricting medications
D. Encouraging smoking cessation
E. Promoting high-impact exercises
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Correct answer: D. Encouraging smoking cessation
Rationale: Smoking is a major risk factor for PAD. Encouraging smoking cessation is crucial in managing PAD to prevent disease progression and improve arterial perfusion. Dietary changes, sedentary lifestyle, vasoconstricting medications, and high-impact exercises are not recommended and may exacerbate the condition.
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Question 6: A patient with PAD experiences severe pain in the lower extremities at rest. The nurse notices cold, pale feet with absent pulses. Which stage of PAD, according to the Rutherford classification, is most likely present?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Stage V
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Correct answer: D. Stage IV
Rationale: The description of severe pain at rest, absent pulses, and severe skin changes (cold and pale feet) indicates critical limb ischemia, characteristic of Stage IV PAD according to the Rutherford classification. Stages I, II, III, and V do not specifically encompass these severe symptoms seen in Stage IV PAD.
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Question 7: A patient with PAD experiences intermittent claudication. Which nursing intervention is most appropriate to manage this symptom?
A. Elevating the legs above heart level
B. Encouraging prolonged walking
C. Applying heating pads to the legs
D. Administering anti-inflammatory medication
E. Encouraging regular, moderate exercise
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Correct answer: E. Encouraging regular, moderate exercise
Rationale: Intermittent claudication in PAD results from inadequate blood flow during exercise. Regular, moderate exercise is recommended as it improves collateral circulation and increases walking distance before onset of pain. Elevating legs, prolonged walking, heating pads, and anti-inflammatory medications are not the mainstay interventions for managing intermittent claudication in PAD.
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Question 8: A 55-year-old patient complains of cramping leg pain during walks that subsides with rest. On examination, the nurse notes diminished pedal pulses and cool skin on the lower extremities. Which test should the nurse recommend to assess the severity of peripheral artery disease (PAD) in this patient?
A. Electrocardiogram (ECG)
B. Venous Doppler ultrasound
C. Ankle-brachial index (ABI)
D. Chest X-ray
E. Complete blood count (CBC)
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Correct answer: C. Ankle-brachial index (ABI)
Rationale: The symptoms described suggest intermittent claudication, a classic presentation of PAD. The ABI is a non-invasive test comparing blood pressure in the arms and legs, indicating the severity of PAD. ECG, Doppler ultrasound, chest X-ray, and CBC are not primary tests for evaluating PAD severity.
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Question 9: A patient is diagnosed with peripheral artery disease (PAD). Which lifestyle modification is most crucial to manage this condition effectively?
A. Reducing water intake
B. Limiting protein consumption
C. Encouraging smoking cessation
D. Promoting caffeine intake
E. Increasing saturated fat intake
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Correct answer: C. Encouraging smoking cessation
Rationale: Smoking is a significant risk factor for PAD, and quitting smoking is crucial in managing and preventing further progression of the disease. Limiting water or protein intake, promoting caffeine intake, or increasing saturated fat intake does not directly address the underlying cause or management of PAD.
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Question 10: A patient with PAD presents with non-healing ulcers on the feet, decreased sensation, and weak pedal pulses. Which stage of peripheral artery disease (PAD) according to the Fontaine classification is most likely present?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Stage V
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Correct answer: B. Stage II
Rationale: The symptoms described, such as ulcers, decreased sensation, and weak pulses, align with Fontaine Stage II PAD. In this stage, patients may experience intermittent claudication along with more severe symptoms like ulcers and diminished pulses. Stages I, III, IV, and V do not encompass this specific combination of symptoms seen in Stage II PAD according to the Fontaine classification.