PRELIMS Practice Tests 3

A client with disseminated intravascular coagulation (DIC) develops bleeding from the gums and multiple ecchymoses. Which finding should the nurse recognize as consistent with DIC? A. Increased platelet count B. Excessive clotting only C. Simultaneous clotting and bleeding D. Increased red blood cell production

C. Simultaneous clotting and bleeding — DIC causes widespread activation of coagulation, which consumes platelets and clotting factors. As a result, the client may develop both abnormal clot formation and severe bleeding.

A client with peripheral arterial disease reports severe burning pain in the toes that awakens the client at night. Which condition does the nurse suspect? A. Intermittent claudication B. Arterial rest pain C. Venous insufficiency D. Varicose veins

B. Arterial rest pain — Rest pain is a severe burning or numb sensation that may occur when the extremity is at rest, particularly at night. It indicates significant arterial insufficiency.

A nurse is assessing a client suspected of having peripheral arterial disease. Which pulse is considered a particularly sensitive and specific indicator of arterial function? A. Radial pulse B. Carotid pulse C. Posterior tibial pulse D. Apical pulse

C. Posterior tibial pulse — The posterior tibial pulse is identified in the material as a sensitive and specific indicator of arterial function in the lower extremities.

A client with peripheral arterial disease asks why the nurse tells them not to cross their legs. What is the best explanation? A. It increases venous pressure. B. It may further restrict arterial blood flow. C. It causes excessive fluid retention. D. It increases the risk of infection.

B. It may further restrict arterial blood flow. — Crossing the legs can compress blood vessels and further decrease circulation to an already ischemic extremity.

A client with peripheral arterial disease has an ankle blood pressure of 80 mmHg and a brachial blood pressure of 100 mmHg. What is the client’s ABI? A. 0.6 B. 0.8 C. 1.2 D. 1.8

B. 0.8 — ABI = ankle pressure ÷ brachial pressure. Therefore, 80 ÷ 100 = 0.8. An ABI below 0.9 is diagnostic of peripheral arterial disease.

A client with peripheral arterial disease asks which exercise is generally most appropriate for improving collateral circulation. Which activity should the nurse recommend? A. Prolonged bed rest B. Walking C. Heavy weightlifting D. Sprinting

B. Walking — Walking is identified as the best exercise for improving collateral circulation in clients with peripheral arterial disease when exercise is appropriate.

A client with severe peripheral arterial disease has gangrene of the toes. The client asks whether they should begin an intensive walking program. What should the nurse do? A. Encourage vigorous walking immediately. B. Encourage running instead. C. Avoid exercise because gangrene is present. D. Have the client exercise until severe pain occurs.

C. Avoid exercise because gangrene is present. — Exercise is not recommended for severe rest pain, venous ulcers, or gangrene because the tissue is already severely compromised.

The nurse is teaching a client how to perform Buerger-Allen exercises. Which sequence is correct? A. Sit → elevate legs → lie flat B. Elevate legs → sit with legs hanging → lie flat C. Lie flat → elevate legs → stand D. Walk → sit → elevate legs

B. Elevate legs → sit with legs hanging → lie flat — The Buerger-Allen exercise consists of elevating the legs for about 2–3 minutes, sitting with the legs hanging for about 3 minutes, and then lying flat for about 5 minutes.

A client with peripheral arterial disease asks how to keep the affected extremity warm. Which instruction is most appropriate? A. Place a heating pad directly against the leg. B. Soak the leg in very hot water. C. Keep the extremity warm but avoid direct heat. D. Apply an electric blanket directly to the skin.

C. Keep the extremity warm but avoid direct heat. — Warmth can promote vasodilation, but direct heat should be avoided because reduced sensation can increase the risk of burns.

A client with peripheral arterial disease is receiving teaching about factors that cause vasoconstriction. Which should the nurse instruct the client to avoid? A. Adequate hydration B. Walking C. Nicotine D. Warmth

C. Nicotine — Nicotine causes vasoconstriction and can worsen peripheral arterial circulation.

A client with peripheral arterial disease asks why adequate fluid intake is encouraged. Which response is most appropriate? A. It prevents blood from becoming excessively viscous. B. It eliminates arterial plaques. C. It increases platelet aggregation. D. It permanently opens blocked arteries.

A. It prevents blood from becoming excessively viscous. — Adequate hydration helps prevent increased blood viscosity, which can further impair circulation.

A client with peripheral arterial disease is prescribed pentoxifylline. The client asks what the medication does. Which response is correct? A. It destroys existing blood clots. B. It improves red blood cell flexibility and blood flow. C. It directly dissolves arterial plaques. D. It increases blood viscosity.

B. It improves red blood cell flexibility and blood flow. — Pentoxifylline improves blood flow by increasing red blood cell flexibility and decreasing blood viscosity.

A client with peripheral arterial disease is prescribed aspirin. The nurse understands that aspirin is primarily used because it

A. Promotes platelet aggregation B. Acts as an antiplatelet medication C. Increases blood viscosity D. Causes vasoconstriction

A client with an arterial occlusion undergoes percutaneous transluminal angioplasty (PTA). What is the purpose of the procedure? A. Remove the entire artery B. Dilate a stenosed or occluded artery C. Increase blood viscosity D. Destroy the heart valves

B. Dilate a stenosed or occluded artery — PTA uses a balloon catheter to dilate a narrowed or occluded artery. A stent may also be placed to help maintain patency.

A young adult male who smokes heavily reports pain in the arch of his foot when walking. Assessment reveals diminished peripheral pulses and cold sensitivity. Which disorder should the nurse suspect? A. Raynaud disease B. Buerger disease C. Varicose veins D. Venous thrombosis

B. Buerger disease — Buerger disease commonly affects young adult men who smoke. An early manifestation is claudication of the arch of the foot.

The nurse provides smoking-cessation teaching to a client diagnosed with Buerger disease. Why is complete tobacco abstinence particularly important? A. It permanently cures the disease. B. It can arrest disease progression. C. It increases arterial obstruction. D. It prevents all infections.

B. It can arrest disease progression. — Complete tobacco cessation can arrest Buerger disease. Continued smoking may cause progressive proximal vessel occlusion.

A client with Buerger disease continues to smoke despite repeated education. Which complication should the nurse recognize as a possible result? A. Improved peripheral circulation B. Progressive ischemia and gangrene C. Increased venous return D. Decreased arterial obstruction

B. Progressive ischemia and gangrene — Continued smoking promotes progression of vascular occlusion, which can lead to peripheral ischemia, ulceration, and gangrene.

A female client reports that her fingers become pale, then blue, and finally red when exposed to cold. She also experiences numbness and pain. Which disorder is most likely? A. Buerger disease B. Raynaud disease C. Deep vein thrombosis D. Varicose veins

B. Raynaud disease — Raynaud disease involves vasospasm that produces a characteristic sequence of pallor/blanching, cyanosis, and then redness as vasodilation occurs.

A client diagnosed with Raynaud disease asks which medication is commonly used to reduce vasospasm. Which medication class should the nurse expect? A. Calcium channel blockers B. Antacids C. Antidiarrheals D. Antihistamines

A. Calcium channel blockers — Calcium channel blockers are the drug of choice for Raynaud disease because they help reduce arterial vasospasm.

A client taking a calcium channel blocker for Raynaud disease reports flushing, headache, dizziness, and a low blood pressure reading. What should the nurse recognize? A. These can be medication side effects. B. These indicate improved circulation only. C. These are signs of DIC. D. These indicate pulmonary embolism.

A. These can be medication side effects. — Calcium channel blockers used for Raynaud disease may cause flushing, headache, hypotension, and dizziness.

A client with severe Raynaud disease continues to have symptoms despite medication. Which intervention may be considered when symptoms remain uncontrolled? A. Lumbar sympathectomy B. Chest tube insertion C. Thoracentesis D. Coronary bypass surgery

A. Lumbar sympathectomy — For severe Raynaud symptoms that do not respond adequately to medication, lumbar sympathectomy may be considered.

A postoperative client suddenly develops unilateral calf swelling and pain. Which condition should the nurse suspect first? A. Varicose veins B. Deep vein thrombosis C. Raynaud disease D. Arterial embolism

B. Deep vein thrombosis — Sudden unilateral leg swelling accompanied by calf or groin tenderness/pain is a classic presentation of DVT.

A client is hospitalized after orthopedic surgery and has been immobile for several days. Why is this client at increased risk for DVT? A. Increased arterial oxygenation B. Venous stasis C. Increased red blood cell flexibility D. Increased collateral circulation

B. Venous stasis — Immobility promotes venous stasis, one component of Virchow’s triad. Endothelial injury and hypercoagulability are the other components.

A client with suspected DVT asks why the nurse does not vigorously massage the painful leg. Which explanation is best? A. Massage increases arterial oxygenation. B. Massage can dislodge the clot and cause an embolus. C. Massage causes the clot to dissolve immediately. D. Massage prevents venous return.

B. Massage can dislodge the clot and cause an embolus. — Massaging an extremity with a suspected DVT may dislodge the thrombus, allowing it to travel through the circulation and potentially cause a pulmonary embolism.

A client with DVT is receiving unfractionated heparin. Which medication should the nurse anticipate administering if severe heparin-induced thrombocytopenia or serious bleeding occurs? A. Vitamin C B. Protamine sulfate C. Alteplase D. Aspirin

B. Protamine sulfate — Protamine sulfate is the antidote for unfractionated heparin and is used when reversal of heparin’s anticoagulant effect is required.

A client is prescribed warfarin after treatment for DVT. The nurse explains that therapeutic anticoagulation with warfarin generally takes

A. Several minutes B. Several hours C. 3–4 days D. Several months

A client receiving thrombolytic therapy for a severe thrombus suddenly develops a severe headache and neurologic changes. What complication should the nurse suspect? A. Intracerebral bleeding B. Improved circulation C. Varicose veins D. Stable angina

A. Intracerebral bleeding — A serious complication of thrombolytic therapy such as alteplase or reteplase is intracerebral bleeding.

A client receiving anticoagulant therapy for DVT asks which activity should be avoided. Which response is most appropriate? A. Walking B. Contact sports C. Light daily activities D. Prescribed ambulation

B. Contact sports — Anticoagulants increase the risk of bleeding. Activities with a high risk of trauma, such as contact sports, should be avoided.

A client has dilated, tortuous veins in the legs and reports that the legs feel heavy after standing for long periods. The discomfort improves when the legs are elevated. Which condition is most likely? A. Varicose veins B. DIC C. Raynaud disease D. Buerger disease

A. Varicose veins — Varicose veins are dilated, tortuous veins commonly involving the saphenous veins. Symptoms such as heaviness and tiredness are often relieved by activity or elevation.

A client with varicose veins asks which intervention can help improve circulation and reduce symptoms. Which instruction should the nurse provide? A. Remain standing for most of the day. B. Avoid all physical activity. C. Walk regularly and avoid prolonged sitting or standing. D. Keep the legs dependent continuously.

C. Walk regularly and avoid prolonged sitting or standing. — Walking promotes venous return. Clients with varicose veins should also avoid prolonged sitting or standing and may benefit from elastic support stockings.