A 52-year-old male is diagnosed with chronic venous insufficiency, presenting with pooling of blood in the veins of the lower extremities and edema.
Which of the following is an expected assessment finding of this disorder?
Skin hyperpigmentation.
Gangrene.
Edema above the knee.
Deep vein thrombus formation.
The Correct Answer is A
Choice A rationale
Skin hyperpigmentation is a common symptom of chronic venous insufficiency. This happens because blood pools in the veins and can leak into the surrounding tissue, causing a change in skin color.
Choice B rationale
Gangrene is not a typical symptom of chronic venous insufficiency. Gangrene is a serious condition that occurs when tissue dies due to a lack of blood flow.
Choice C rationale
Edema, or swelling, is a common symptom of chronic venous insufficiency, but it typically occurs in the lower legs and ankles, not above the knee.
Choice D rationale
Deep vein thrombus formation is not a typical symptom of chronic venous insufficiency. However, a history of deep vein thrombosis can increase the risk of developing chronic venous insufficiency.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The patient with a blood pressure of 116/42 mm Hg has a mean arterial pressure (MAP) of approximately 67 mm Hg, which is less than the standard policy of 70 mm Hg. This could indicate inadequate blood flow to the vital organs, necessitating notification of the healthcare provider.
Correct Answer is B
Explanation
Choice A rationale
Assessing the need for smoking cessation is a standard part of nursing care, especially for patients with circulatory issues. Smoking can exacerbate circulatory problems and delay wound healing.
Choice B rationale
Applying TED hose to bilateral legs might not be appropriate for this patient. TED hose are compression stockings designed to prevent deep vein thrombosis and promote circulation.
However, in a patient with weak pedal pulses and a full-thickness wound on the leg, the compression from the stockings could potentially worsen circulation to the area and impede wound healing.
Choice C rationale
Consulting physical therapy could be beneficial for this patient. Physical therapists can provide exercises and interventions to improve circulation and mobility, which could help with the patient’s circulatory issues and wound healing.
Choice D rationale
Obtaining an Ankle-Brachial Index (ABI) with a hand-held Doppler could be useful in this situation. The ABI is a simple, non-invasive test that can help diagnose peripheral artery disease (PAD), a condition that could be causing the patient’s weak pedal pulses and wound healing issues.
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