Family Nurse Practitioner Exam

When evaluating a patient for intermittent claudication, what is the first step?

1. Order a venogram

2. Order T.E.D. anti-embolism stockings

3. Check the ankle and brachial blood pressure before and after exercise

4. Check the pedal and posterior tibial pulses

The correct answer is: Check the ankle and brachial blood pressure before and after exercise

Evaluating a patient for intermittent claudication begins with checking the ankle and brachial blood pressure before and after exercise because this procedure helps to determine the presence and severity of peripheral arterial disease (PAD). By measuring these blood pressures, you can calculate the ankle-brachial index (ABI), a crucial diagnostic tool. The ABI provides a direct assessment of blood flow, allowing clinicians to identify whether there is a significant decrease in blood pressure in the ankle due to arterial blockage. This step is important because it provides quantitative evidence of arterial sufficiency and helps guide further diagnostic and management decisions. Once the ABI is established, additional investigations or interventions can be planned based on the results. While checking the pedal and posterior tibial pulses could also provide useful information about blood flow to the extremities, it does not give the quantitative assessment that the ABI does. The other options, such as ordering a venogram or T.E.D. stockings, are not first-line evaluations for intermittent claudication and are more suitable in other contexts or stages of management.