A nurse is developing a discharge teaching plan for a patient diagnosed with peripheral arterial disease. Which instruction will the nurse include in the plan?

A. Chest pain that radiates to the jaw:
This finding suggests myocardial ischemia, as chest pain (angina) that radiates to the jaw is a classic symptom of cardiac origin. It is known as referred pain and occurs because the nerves that innervate the heart and jaw have a similar sensory pathway. The pain may be described as pressure, squeezing, or tightness in the chest, and it often spreads to the neck, shoulders, arms, or jaw. This pattern of pain radiation is typical in myocardial ischemia or heart attack due to inadequate blood supply to the heart muscle.

B. Sudden and severe abdominal pain:
While abdominal pain can be associated with various conditions, sudden and severe abdominal pain is not a typical symptom of myocardial ischemia. Instead, it may indicate other abdominal issues such as gastrointestinal problems, pancreatitis, or intra-abdominal vascular events. Myocardial ischemia typically presents with chest pain or discomfort, rather than abdominal pain.

C. Blurred vision:
Blurred vision is not a typical symptom of myocardial ischemia. It may suggest ocular issues such as refractive errors, dry eyes, or conditions affecting the retina or optic nerve. Myocardial ischemia primarily manifests with symptoms related to the heart, such as chest pain, shortness of breath, or other signs of cardiovascular compromise.

D. Dry cough:
A dry cough is not a typical symptom of myocardial ischemia. It may be associated with various respiratory conditions such as allergies, asthma, or respiratory infections. Myocardial ischemia primarily presents with symptoms related to the heart and cardiovascular system, such as chest pain, palpitations, or dyspnea.

Answer: D

Rationale:

A) A renal ultrasound: A renal ultrasound is not typically used to confirm a diagnosis of hypertension. While renal artery stenosis can contribute to hypertension in some cases, it is not the primary diagnostic test for hypertension.

B) A cardiac stress test: A cardiac stress test is not used to confirm a diagnosis of hypertension. It is primarily used to assess cardiovascular function and detect coronary artery disease or cardiac arrhythmias.

C) A manual blood pressure cuff: While manual blood pressure measurements can provide accurate readings, they are subject to potential inaccuracies due to factors such as observer bias and white coat syndrome. Therefore, they may not be the most reliable method for confirming a diagnosis of hypertension.

D) Ambulatory blood pressure measurement: Ambulatory blood pressure measurement involves obtaining multiple blood pressure readings over a 24-hour period using a portable monitor. It is considered the gold standard for diagnosing hypertension, as it provides a more comprehensive assessment of blood pressure variability and reduces the impact of white coat syndrome. Therefore, it is the preferred diagnostic test in this scenario to confirm whether the patient has hypertension outside of the clinical setting.