A nurse is collecting data from a client who has venous insufficiency. Which of the following findings should the nurse expect?
Thickened toenails
Shiny, thin skin on the lower extremities
Dusky, red color of the feet when dangling
Pitting edema
The Correct Answer is D
Choice A reason : Thickened toenails are often associated with fungal infections and are not a direct symptom of venous insufficiency. However, they can appear in patients with chronic venous insufficiency due to poor circulation that affects the health of the toenails.
Choice B reason : Shiny, thin skin on the lower extremities is more characteristic of arterial insufficiency, where there is a reduction in blood flow and oxygen to the tissues. In venous insufficiency, the skin may instead appear thickened and discolored due to stasis and buildup of hemosiderin from the breakdown of red blood cells.
Choice C reason : A dusky, red color of the feet when dangling can be a sign of dependent rubor, which is associated with arterial insufficiency. This occurs when there is a severe decrease in arterial blood flow to the lower extremities. Venous insufficiency may cause a different color change, typically a brownish discoloration due to hemosiderin deposition.
Choice D reason : Pitting edema is a hallmark sign of venous insufficiency. It occurs due to the accumulation of fluid in the tissues, which is a result of increased pressure in the veins. This pressure causes fluid to leak into the surrounding tissues, leading to swelling that retains an indentation when pressed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason : Setting a goal body weight within 25% of the ideal body weight can be misleading. The ideal body weight should be determined based on body mass index (BMI), considering the individual's height and weight. A BMI of 18.5 to 24.9 is considered normal.
Choice B reason : This is a general guideline for alcohol consumption, but for individuals with hypertension, it is often recommended to limit alcohol intake even further to help manage blood pressure
Choice C reason : This is a key recommendation for managing hypertension. Reducing sodium intake helps lower blood pressure and is a widely accepted guideline
Choice D reason : Monitoring potassium levels is crucial when taking thiazide diuretics because these medications can decrease potassium levels in the blood, leading to hypokalemia.
Correct Answer is ["2"]
Explanation
Step 1 is to identify the prescribed dose of digoxin, which is 0.25 mg.
Step 2 is to identify the amount of digoxin available per tablet, which is 0.125 mg/tablet.
Step 3 is to calculate the number of tablets the nurse should administer per dose. This is done by dividing the prescribed dose by the amount available per tablet. So, 0.25 mg ÷ 0.125 mg/tablet = 2 tablets.
The nurse should administer 2 tablets per dose.
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