A nurse is collecting data from a client who has peripheral arterial disease (PAD). Which of the following findings should the nurse expect?
Intermittent claudication
Darkened skin color near extremities
Warm extremities
Edema
The Correct Answer is A
Choice A reason f:Intermittent claudication is a classic symptom of PAD, characterized by muscle pain or cramping in the legs triggered by exercise, such as walking, which typically disappears after a few minutes of rest. This symptom occurs due to inadequate blood flow to the muscles during increased demand.
Choice B reason :Darkened skin color near the extremities, also known as hyperpigmentation, can occur in PAD due to the chronic ischemia and the resultant buildup of waste products in the tissue, which may lead to skin changes.
Choice C reason :Warm extremities are not typically associated with PAD. In fact, patients with PAD may have cooler extremities compared to the rest of the body due to reduced blood flow.
Choice D reason :Edema is not a common finding in PAD. Instead, PAD can lead to decreased skin temperature, loss of hair, shiny skin, and non-healing wounds on the extremities due to poor circulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason : In atrial fibrillation, the heartbeat is known to be irregular and often rapid. This irregularity is due to the disorganized electrical signals in the heart's upper chambers, which cause a fast and chaotic heartbeat. Therefore, when documenting the pulse of a client with atrial fibrillation, the term "irregular" is appropriate.
Choice B reason : "Not palpable" would indicate that the pulse cannot be felt, which is not typically the case with atrial fibrillation. While the pulse may be irregular, it is usually still palpable unless the rate is extremely rapid or associated with other complications.
Choice C reason : "Bounding" refers to a pulse that feels strong and full. This is not characteristic of atrial fibrillation. Instead, the pulse in atrial fibrillation may feel weak and irregular due to the ineffective contraction of the atria.
Choice D reason : "Regular" is not an appropriate term to describe the pulse in a client with atrial fibrillation because the condition is characterized by an irregular heart rhythm. The term would be used for a pulse that has consistent beats at regular intervals, which is not the case in atrial fibrillation.
Correct Answer is D
Explanation
Choice A reason : Applying ice to the extremity is not a standard intervention for DVT. Ice is typically used to reduce inflammation and pain, but in the case of DVT, the priority is to prevent the clot from growing and embolizing. The use of warmth, not cold, may be recommended to help reduce discomfort and swelling.
Choice B reason : Administering vasodilating medications is not a typical intervention for DVT. Vasodilators are used to widen blood vessels and improve blood flow, but they do not address the risk of clot formation or embolization associated with DVT. The mainstay of medical treatment for DVT is anticoagulant therapy, which helps to prevent further clotting.
Choice C reason : Restricting oral fluids is not an intervention for DVT. Adequate hydration is important in the management of DVT as it can help to prevent blood from thickening and reduce the risk of further clot formation. There is no indication to restrict fluids unless there is another underlying condition that requires it.
Choice D reason : Monitoring platelet levels is an important intervention in the care of a client with DVT, especially if they are receiving anticoagulant therapy. Anticoagulants can affect platelet function and count, and monitoring is necessary to ensure safe levels and prevent complications such as bleeding or thrombocytopenia.
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