# A nurse is caring for a 68-year-old client with peripheral arterial disease who presents with intermittent claudication and reports severe cramping pain in both calves after walking one block.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=177024  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a 68-year-old client with peripheral arterial disease who presents with intermittent claudication and reports severe cramping pain in both calves after walking one block.

## 보기

1. Encourage the client to stop activity and rest until pain subsides **✔ 정답**
2. Apply warm compresses to the affected extremities for relief
3. Elevate the client's legs above heart level for comfort
4. Administer prescribed analgesics immediately for pain

**정답: 1**

## 해설

Stopping activity and resting is the priority to relieve ischemic pain by reducing tissue oxygen demand. Other options like warm compresses or leg elevation may worsen symptoms in PAD.

## 심화 해설

Understanding the Pathophysiology of Intermittent Claudication

The client's report of severe cramping pain in both calves after walking one block is a classic presentation of intermittent claudication, the most common manifestation of peripheral arterial disease (PAD) [2]. In PAD, atherosclerotic plaques narrow the arterial lumen in the lower extremities. At rest, the restricted blood flow may be sufficient to meet the metabolic demands of the muscles. However, during exercise such as walking, the oxygen demand of the gastrocnemius muscles increases dramatically. The fixed, stenotic vessels cannot dilate to deliver the required increase in blood flow, leading to a supply-demand mismatch. This results in muscle ischemia and the accumulation of metabolic waste products, which triggers the characteristic cramping, aching pain [2]. The pain is reproducible at a specific distance because it is directly tied to a consistent level of metabolic demand exceeding a fixed oxygen supply.

Rationale for the Correct Intervention: Rest

The most immediate, evidence-based nursing action is to encourage the client to stop activity and rest until the pain subsides. This intervention directly addresses the underlying pathophysiological mechanism. Stopping the walking activity immediately reduces the metabolic oxygen demand of the calf muscles. As the demand falls back to a level that can be met by the limited resting blood flow, the ischemic process is reversed. Metabolic wastes are cleared, and the pain resolves without the need for any pharmacological intervention. This aligns with the natural history of the condition, which is described as a lifestyle-limiting disease where pain is a key barrier to physical activity [2,3]. Teaching the client this self-management strategy is a cornerstone of care, empowering them to control their symptoms and safely engage in necessary daily activities.

Analysis of Incorrect Options

The other options are incorrect because they either contradict the physiological goal of PAD management or represent a secondary, rather than primary, intervention.

- Applying warm compresses: This is a potentially harmful action. In an ischemic limb, the application of direct heat can increase the metabolic rate and oxygen demand of the local tissues, paradoxically worsening the ischemia. Furthermore, due to compromised circulation, the limb may have reduced sensation, increasing the risk of a thermal burn. The primary goal is not to vasodilate the area externally but to reduce oxygen demand.

- Elevating the legs: This action would further compromise arterial blood flow. Elevation works against gravity, making it more difficult for the already-inadequate arterial circulation to perfuse the lower extremities. This position is beneficial for promoting venous return (e.g., in venous insufficiency) but is contraindicated in arterial insufficiency. To relieve PAD pain, the dependent position (legs dangling) is used to allow gravity to assist blood flow.

- Administering prescribed analgesics immediately: While pain management is important, pharmacological intervention is not the first-line response for predictable, activity-induced claudication pain. Rest alone is highly effective and avoids unnecessary medication use. Furthermore, societal guidelines emphasize that the foundation of treatment for claudication is optimal medical therapy (OMT) and supervised exercise therapy (SET), which actually encourages walking to the point of pain, resting, and then resuming, to stimulate collateral circulation development over time [2,4]. Immediately medicating for this expected pain would bypass a key non-pharmacological strategy and could mask a significant clinical indicator of disease severity. The long-term goal is to improve functional capacity, lower-extremity muscle strength, and quality of life through structured programs, not to simply eliminate the pain signal at its first occurrence [1,4].References (research sources)

- [2]Novel Interventions to Improve Adherence to Guideline-Directed Medical Therapy in Claudicants.GuidelineShi R, Bulatao N, Tanious A. (2025) · DOI: 10.3390/jcm14155309

## 임상 시나리오

PAD & Intermittent Claudication: Immediate CareManaging Exercise-Induced Ischemic Pain
The primary intervention for intermittent claudication is to stop activity and rest. This immediately reduces the oxygen demand of the calf muscles, correcting the supply-demand mismatch caused by fixed arterial stenosis.

Pain typically subsides within 1 to 3 minutes of rest without the need for analgesics. The client should remain in a dependent position (legs hanging down) to use gravity to aid arterial blood flow.

CautionNever apply direct heat to ischemic limbs, as it increases metabolic demand and can burn insensate skin. Do not elevate the legs, which further reduces arterial perfusion pressure and worsens pain.

## 핵심 개념

- **Intermittent Claudication** — Reproducible cramping muscle pain during exercise caused by inadequate arterial blood flow, relieved by rest.
- **Peripheral Arterial Disease (PAD)** — Atherosclerotic narrowing of arteries in the extremities, leading to reduced blood flow and ischemia.
- **Supply-Demand Mismatch** — A state where metabolic oxygen demand of tissues exceeds the supply delivered by a fixed, stenotic blood vessel.

## 같은 주제 문제

- [A nurse is assessing a 45-year-old client with hypertension and a family history of cardio…](https://mymerci.kr/pages/nclex_q.php?qn_id=177019)
- [A nurse is assessing a 72-year-old client with a history of diabetes and suspected periphe…](https://mymerci.kr/pages/nclex_q.php?qn_id=177021)
- [A nurse is assessing a 55-year-old client with suspected peripheral arterial disease](https://mymerci.kr/pages/nclex_q.php?qn_id=177022)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._