A nurse is teaching a client who has peripheral arterial disease. Which of the following statements should the nurse include in the teaching to explain peripheral arterial disease?

"Blood flow is altered and causes blood to pool in the legs."

"Blood flow is altered due to atherosclerosis affecting the tissues' ability to receive oxygen-rich blood."

"Blood flow is altered due to incompetent valves causing increased venous pressure."

"Blood flow is altered due to excessive stretching of the ventricles impairing the heart to contract."

Answer and Explanation

The Correct Answer is B

A. "Blood flow is altered and causes blood to pool in the legs." This statement inaccurately describes venous insufficiency rather than peripheral arterial disease (PAD). In PAD, blood flow is reduced or obstructed due to atherosclerosis, leading to inadequate oxygen supply to tissues rather than pooling of blood in the legs.

B. "Blood flow is altered due to atherosclerosis affecting the tissues' ability to receive oxygen-rich blood." This statement correctly explains the underlying pathology of peripheral arterial disease (PAD). Atherosclerosis, characterized by the buildup of plaque in the arteries, narrows or blocks blood flow, impairing the delivery of oxygen-rich blood to the tissues. This can result in symptoms such as pain, cramping, and tissue damage, especially during activity when oxygen demand increases.

C. "Blood flow is altered due to incompetent valves causing increased venous pressure." This statement describes venous insufficiency rather than PAD. In venous insufficiency, faulty valves in the veins result in increased venous pressure, leading to symptoms such as swelling, heaviness, and varicose veins, but it does not involve arterial obstruction as seen in PAD.

D. "Blood flow is altered due to excessive stretching of the ventricles impairing the heart to contract." This statement describes a condition related to the heart's function rather than peripheral arterial disease. Excessive stretching of the ventricles may occur in conditions such as heart failure, but it does not directly affect blood flow in the peripheral arteries as seen in PAD.

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Correct Answer is C

Explanation

A. Relocation stress syndrome: Relocation stress syndrome refers to the physical and psychological symptoms experienced by individuals when they are moved from one environment to another, such as transitioning to a new residence or healthcare facility. While relocation stress syndrome can cause agitation and confusion in individuals with Alzheimer's disease, the scenario provided does not indicate a recent relocation.

B. Wandering: Wandering is a common behavior observed in individuals with dementia, where they aimlessly roam or wander in their environment. While wandering may be associated with agitation and restlessness, the scenario does not describe the client physically moving around or attempting to leave their home.

C. Sundowning: Sundowning refers to a phenomenon commonly observed in individuals with Alzheimer's disease or other forms of dementia, where they experience increased agitation, confusion, and restlessness in the late afternoon or early evening hours. Sundowning behaviors can include pacing, agitation, anxiety, irritability, confusion, and difficulty sleeping. The exact cause of sundowning is not fully understood but may be related to factors such as fatigue, sensory overload, hormonal imbalances, or disruptions in the sleep-wake cycle. Managing sundowning behaviors often involves creating a calming environment, maintaining a consistent daily routine, minimizing stimuli in the evening, and providing reassurance and comfort to the individual.

D. Depression: Depression can occur in individuals with Alzheimer's disease and may present with symptoms such as sadness, hopelessness, loss of interest in activities, changes in appetite or sleep patterns, and difficulty concentrating. However, the scenario primarily describes agitation and restlessness in the evening hours, which is characteristic of sundowning rather than depression.

A. A decrease in systolic blood pressure greater than 10 mm Hg during inspiration B. A decrease in heart rate greater than 10/min when lying down C. An increase in diastolic blood pressure greater than 10 mm Hg during inspiration D. An increase in heart rate greater than 20/min when standing

Correct Answer is A

Explanation

A. A decrease in systolic blood pressure greater than 10 mm Hg during inspiration: Pulsus paradoxus is an exaggerated decrease in systolic blood pressure during inspiration. Normally, there is a slight decrease in systolic blood pressure during inspiration due to increased intrathoracic pressure and decreased venous return to the heart. However, in conditions such as cardiac tamponade or severe asthma exacerbations, the decrease in systolic blood pressure during inspiration is more pronounced (>10 mm Hg), indicating impaired cardiac output and decreased left ventricular filling during inspiration.

B. A decrease in heart rate greater than 10/min when lying down: This finding is not indicative of pulsus paradoxus. Pulsus paradoxus primarily refers to changes in systolic blood pressure during inspiration rather than alterations in heart rate when lying down.

C. An increase in diastolic blood pressure greater than 10 mm Hg during inspiration: This finding is not indicative of pulsus paradoxus. Pulsus paradoxus is characterized by an exaggerated decrease in systolic blood pressure during inspiration, not changes in diastolic blood pressure.

D. An increase in heart rate greater than 20/min when standing: This finding is not indicative of pulsus paradoxus. Pulsus paradoxus primarily refers to changes in systolic blood pressure during inspiration rather than alterations in heart rate when standing.

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Correct Answer is C

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