A nurse is establishing a baseline postoperative assessment for a client who is recovering from a right femoropopliteal bypass graft. Which of the following findings in the assessment of the client's right leg should be of the most concern to the nurse?

The client's foot feels cooler than in the previous assessment.

The client's pedal pulse in the right foot is not palpable.

The client's capillary refill time is 5 seconds in the toes.

The client reports a pain level of 8 on a scale from 0 to 10.

Answer and Explanation

The Correct Answer is B

The most concerning finding in the assessment of a client's right leg after a femoropopliteal bypass graft would be if the client's pedal pulse in the right foot is not palpable. This could indicate a problem with blood ﬂow to the limb.

The other options are also concerning and should be reported to the healthcare provider.

a) A cooler foot may indicate decreased blood ﬂow to the limb.

c) A capillary refill time of 5 seconds may also indicate decreased blood ﬂow.

d) A pain level of 8 on a scale from 0 to 10 should also be reported and addressed.

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Correct Answer is D

Explanation

Neisseria gonorrhoeae is the bacterium responsible for the sexually transmitted infection known as gonorrhea. Gonorrhea is a reportable communicable disease, meaning healthcare providers are required to report cases to the appropriate public health authorities. This allows for tracking and monitoring of the disease, implementation of appropriate public health measures, and prevention of further spread of the infection.

Sarcoptes scabiei: This refers to scabies, a parasitic infestation caused by mites. While scabies can be contagious, it is not typically a reportable disease to the state health department.

Impetigo contagiosa: Impetigo is a bacterial skin infection that can be caused by various bacteria, including Staphylococcus aureus and Streptococcus pyogenes. Although it is contagious, it is not typically a reportable disease to the state health department.

Human papillomavirus (HPV): HPV is a viral infection transmitted through sexual contact. While it is a significant public health concern due to its association with cervical cancer and other conditions, it is not usually a reportable disease to the state health department. However, certain states may have specific reporting requirements for HPV-related diseases or conditions, such as cervical cancer. It is important to be familiar with the specific reporting guidelines of the state in question.

A. Flush the tubing. B. Clamp the tubing C. Check patency of the tubing D. Aspirate the tubing

Correct Answer is A

No explanation

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A nurse is establishing a baseline postoperative assessment for a client who is recovering from a right femoropopliteal bypass graft. Which of the following findings in the assessment of the client's right leg should be of the most concern to the nurse?

Nursing Test Bank

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