A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?

Cold and numb sensation distal to the fistula site

A raised red rash around the fistula site

Pain in the right arm proximal to the fistula site

Foul-smelling drainage from the fistula site

Answer and Explanation

The Correct Answer is A

Choice A: Cold and numb sensation distal to the fistula site is a possible indication of venous insufficiency. Venous insufficiency is a condition in which the veins have difficulty returning blood from the limbs to the heart, resulting in blood pooling and reduced perfusion. A new arteriovenous fistula can cause increased blood ﬂow through the artery and decreased blood ﬂow through the vein, leading to venous insufficiency. This can manifest as coldness, numbness, tingling, or cyanosis in the fingers or hand below the fistula site.

Choice B: A raised red rash around the fistula site is not a possible indication of venous insufficiency. A raised red rash around the fistula site can indicate an allergic reaction, an infection, or an inﬂammation of the skin or subcutaneous tissue. The nurse should assess the rash for size, shape, color, texture, temperature, and drainage, and report any signs of infection or inﬂammation, such as fever, pus, or swelling.

Choice C: Pain in the right arm proximal to the fistula site is not a possible indication of venous insufficiency. Pain in the right arm proximal to the fistula site can indicate arterial insufficiency, which is a condition in which the arteries have difficulty delivering oxygen-rich blood to the tissues, resulting in ischemia and necrosis. Arterial insufficiency can be caused by atherosclerosis, thrombosis, embolism, or vasospasm. The nurse should assess the pain for location, intensity, duration, frequency, and quality, and report any signs of ischemia or necrosis, such as pallor, coolness, weak pulses, or ulceration.

Choice D: Foul-smelling drainage from the fistula site is not a possible indication of venous insufficiency. Foul-smelling drainage from the fistula site can indicate an infection of the fistula or surrounding tissue. The nurse should assess the drainage for color, odor, amount, and consistency, and report any signs of infection or sepsis, such as fever, chills, malaise, or hypotension.

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Correct Answer is D

Explanation

Choice A Reason: This is incorrect because these values indicate respiratory alkalosis, which is caused by hyperventilation or excess loss of carbon dioxide (PaCO2). Respiratory alkalosis increases the blood pH and decreases the HCO3- level.

Choice B Reason: This is incorrect because these values indicate metabolic alkalosis, which is caused by excess intake or retention of bases or loss of acids. Metabolic alkalosis increases the blood pH and the HCO3- level.

Choice C Reason: This is incorrect because these values indicate respiratory acidosis, which is caused by hypoventilation or excess retention of carbon dioxide (PaCO2). Respiratory acidosis decreases the blood pH and increases the HCO3- level.

Choice D Reason: This is correct because these values indicate metabolic acidosis, which is a common complication of chronic kidney disease. These values indicate metabolic acidosis, which is a common complication of chronic kidney disease. Metabolic acidosis occurs when the kidneys are unable to excrete excess acids or retain enough bicarbonate (HCO3-), which is a base that buﬀers the blood pH. As a result, the blood pH decreases and becomes more acidic. The normal range for blood pH is 7.35 to 7.45, for HCO3- is 22 to 26 mEq/L, and for PaCO2 is 35 to 45 mm Hg.

A. To slow the response of the ventricles to the fast atrial impulses B. To dissolve clots in the bloodstream C. To reduce the risk of stroke in clients who have atrial fibrillation D. To convert atrial fibrillation to sinus rhythm

Correct Answer is C

Explanation

Choice A Reason: This is incorrect because dabigatran does not aﬀect the electrical activity of the heart or the conduction system. It does not slow down the ventricular response to the atrial impulses.

Choice B Reason: This is incorrect because dabigatran does not dissolve existing clots in the bloodstream. It only prevents new clots from forming.

Choice C Reason: This is correct because dabigatran reduces the risk of stroke in clients who have atrial fibrillation by preventing clot formation and reducing blood viscosity. Dabigatran is an anticoagulant medication that prevents the formation of blood clots in the heart and blood vessels. Atrial fibrillation is a condition where the atria beat irregularly and rapidly, which can cause blood to pool and clot in the heart chambers. These clots can travel to the brain and cause a stroke. Dabigatran reduces the risk of stroke by preventing clot formation and reducing blood viscosity.

Choice D Reason: This is incorrect because dabigatran does not restore normal sinus rhythm in clients who have atrial fibrillation. It does not aﬀect the heart rate or rhythm.

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A nurse is providing discharge teaching to a client who has a new arteriovenous fistula in the right forearm. Which of the following manifestations should the nurse include in the teaching as a possible indication of venous insufficiency?

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