An older patient with chronic atrial fibrillation develops sudden severe pain, pulselessness, pallor, and coolness in the right leg, consistent with acute arterial occlusion.
After the nurse notifies the healthcare provider, what should the nurse do next?
Elevate the leg above the level of the heart.
Assist the patient in gently exercising the leg.
Apply a compression stocking to the leg.
Keep the patient in bed in the supine position.
The Correct Answer is D
Choice A rationale
Elevating the leg above the level of the heart would not be beneficial in this case. This action would actually reduce blood flow to the leg, which is already compromised due to the arterial occlusion.
Choice B rationale
Exercising the leg would increase the oxygen demand of the tissues in the leg, which could exacerbate the problem. The tissues in the leg are already deprived of oxygen due to the arterial occlusion.
Choice C rationale
Applying a compression stocking to the leg would not be beneficial in this case. This action would further compromise blood flow to the leg, which is already reduced due to the arterial occlusion.
Choice D rationale
Keeping the patient in bed in the supine position is the correct action. This position will decrease the oxygen demand of the tissues in the leg and minimize ischemic damage until circulation can be restored.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Furosemide (Lasix) is a diuretic often used in the treatment of pulmonary edema to help remove excess fluid from the body. While it’s important to monitor the patient’s fluid and electrolyte balance, it’s not typically necessary to question this medication.
Choice B rationale
Captopril (Capoten) is an ACE inhibitor used to treat conditions like heart failure and high blood pressure. It can be beneficial in managing pulmonary edema by reducing the workload on the heart. It’s not typically necessary to question this medication.
Choice C rationale
Digoxin (Lanoxin) is a medication used to treat heart failure and atrial fibrillation. It’s important to question this medication before administration because digoxin has a narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose is small. Therefore, it’s crucial to ensure the patient’s digoxin levels are within the therapeutic range before administering more of the medication.
Choice D rationale
Carvedilol (Coreg) is a beta-blocker used to treat high blood pressure and heart failure. While it’s important to monitor the patient’s blood pressure and heart rate, it’s not typically necessary to question this medication.
Correct Answer is D
Explanation
Choice A rationale
Exercise electrocardiography, also known as a stress test, is not typically the first-line emergent procedure for a patient with an acute myocardial infarction (AMI). This test is often used to diagnose coronary artery disease, but it is not typically used to treat an AMI5.
Choice B rationale
A computed tomography (CT) scan of the chest with contrast could be used to visualize the heart and surrounding structures, but it is not typically the first-line emergent procedure for a patient with an AMI5.
Choice C rationale
An echocardiogram could be used to visualize the heart’s structure and function, but it is not typically the first-line emergent procedure for a patient with an AMI5.
Choice D rationale
Percutaneous coronary intervention (PCI) is the correct answer. This procedure is often used as an emergent treatment for an AMI. It involves using a catheter to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup.
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