A nurse is teaching a client who has peripheral arterial disease.
Which of the following statements should the nurse include in the teaching to explain peripheral arterial disease?

Choice A rationale

Administering nitroglycerin is a standard treatment for chest pain because it induces vasodilation of the coronary arteries. However, prioritizing it over oxygen in a patient with an oxygen saturation of 89 percent is incorrect. Nitroglycerin can significantly lower blood pressure, and it should only be administered after assessing hemodynamic stability. In this clinical scenario, addressing the documented hypoxemia takes precedence to ensure myocardial tissue receives adequate oxygenation to prevent further ischemic damage.

Choice B rationale

Supplemental oxygen is the priority because the patient is hypoxemic, with a saturation below the normal range of 95 to 100 percent. Oxygen therapy increases the partial pressure of oxygen in the blood, enhancing delivery to the myocardium. Correcting hypoxemia reduces the workload on the heart and limits the size of the infarction. Current guidelines emphasize maintaining oxygen saturation at or above 94 percent to optimize cellular respiration and prevent systemic metabolic acidosis.

Choice C rationale

The supine position is not ideal for a patient experiencing chest pain and respiratory distress because it increases venous return and cardiac preload, potentially worsening pulmonary congestion. Positioning the patient in semi-Fowler or high-Fowler position is usually preferred to facilitate lung expansion. While morphine is used for pain that is unresponsive to nitrates, it is not the first priority. Oxygenation must be addressed immediately to mitigate the underlying cause of the myocardial hypoxia.

Choice D rationale

Thrombolytic therapy is a critical intervention for ST-segment elevation myocardial infarction when percutaneous intervention is unavailable, but it is never initiated before establishing vascular access and confirming the diagnosis via a 12-lead ECG. Furthermore, safety screening for contraindications like recent surgery or bleeding disorders is mandatory. Starting this treatment without basic stabilization, such as oxygen administration for a desaturating patient, violates the primary assessment sequence of airway, breathing, and circulation.

Choice A rationale

Pulmonary edema occurs when fluid backs up into the lungs, usually due to left-sided heart failure. While pericardial fluid can affect heart function, pulmonary edema is not the most immediate or direct complication of fluid accumulation within the pericardial sac itself. Instead, the fluid in the sac creates external pressure on the heart. The focus of care for increased pericardial fluid is the restriction of cardiac filling rather than the primary congestion of the pulmonary vasculature.

Choice B rationale

Cardiac tamponade is a life-threatening condition where the accumulation of fluid in the pericardial sac increases intrapericardial pressure. This pressure prevents the heart chambers from expanding fully during diastole, which severely reduces stroke volume and cardiac output. Common signs include Beck's triad: hypotension, jugular venous distention, and muffled heart sounds. Immediate intervention is required because the heart can eventually stop beating entirely as it becomes unable to fill with blood due to external compression.

Choice C rationale

Pericarditis is the inflammation of the pericardium, which is often the underlying cause of fluid accumulation, known as pericardial effusion. While the nurse monitors for signs of inflammation, the question asks for a complication resulting from the fluid being dangerously increased. Pericarditis is the state of the tissue rather than the acute hemodynamic consequence of fluid volume. Therefore, preventing the functional collapse of the heart takes precedence over managing the inflammatory process in an emergency.

Choice D rationale

Pericardiocentesis is a medical procedure used to drain excess fluid from the pericardial sac to relieve pressure on the heart. It is a treatment modality rather than a complication. The nurse collaborates with the team to perform this procedure in order to treat or prevent cardiac tamponade. Since the question asks for a complication to prevent, choosing a treatment is logically incorrect. The goal is to avoid the physiological crisis that necessitates such an invasive intervention.