In assessing a client with ulcers on the lower extremity, which findings indicate that the ulcers are likely to be of venous, rather than arterial, origin?

Choice A reason: Potassium 4.7 mEq/L (4.70 mmol/L) is within the normal reference range of 3.5 to 5 mEq/L (3.5 to 5 mmol/L). Potassium is an electrolyte that helps regulate the balance of fluids and acids in the body, as well as the function of nerves and muscles. A high potassium level (hyperkalemia) can cause muscle weakness, irregular heartbeat, and cardiac arrest. A low potassium level (hypokalemia) can cause muscle cramps, fatigue, and arrhythmias.

Choice B reason: Magnesium 2.1 mEq/L (0.86 mmol/L) is within the normal reference range of 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L). Magnesium is an electrolyte that helps regulate the activity of enzymes, muscles, and nerves, as well as the balance of calcium and potassium in the body. A high magnesium level (hypermagnesemia) can cause nausea, vomiting, flushing, muscle weakness, and respiratory depression. A low magnesium level (hypomagnesemia) can cause muscle twitching, tremors, seizures, and cardiac arrhythmias.

Choice C reason: Calcium 6.5 mg/dL (1.63 mmol/L) is below the normal reference range of 9 to 10.5 mg/dL (2.3 to 2.6 mmol/L). Calcium is an electrolyte that helps regulate the function of muscles, nerves, bones, and blood clotting. A high calcium level (hypercalcemia) can cause nausea, vomiting, constipation, confusion, kidney stones, and bone pain. A low calcium level (hypocalcemia) can cause muscle spasms, cramps, tingling, numbness, and stridor (a high-pitched sound when breathing). **This is a critical value that should be immediately reported to the healthcare provider**, as it can indicate a serious condition such as acute pancreatitis, sepsis, or massive blood transfusion.

Choice D reason: Sodium 135 mEq/L (135 mmol/L) is slightly below the normal reference range of 136 to 145 mEq/L (136 to 145 mmol/L). Sodium is an electrolyte that helps regulate the balance of fluids and acids in the body, as well as the function of nerves and muscles. A high sodium level (hypernatremia) can cause thirst, dry mouth, confusion, seizures, and coma. A low sodium level (hyponatremia) can cause headache, nausea, vomiting, fatigue, muscle weakness, and confusion.

Choice A reason: Rocky Mountain spotted fever is not the most likely condition for the client who has a severe headache, fever, nuchal rigidity, and a petechial rash on arms and legs. Rocky Mountain spotted fever is a bacterial infection transmitted by ticks that causes a distinctive rash that usually begins on the wrists and ankles and spreads to the rest of the body. The rash is not limited to the arms and legs, and the client may also have other symptoms such as nausea, vomiting, abdominal pain, and muscle aches.

Choice B reason: Intracerebral hemorrhage is not the most likely condition for the client who has a severe headache, fever, nuchal rigidity, and a petechial rash on arms and legs. Intracerebral hemorrhage is a type of stroke that occurs when a blood vessel bursts inside the brain, causing bleeding and swelling. The rash is not a typical sign of intracerebral hemorrhage, and the client may also have other symptoms such as weakness, numbness, vision loss, confusion, and loss of consciousness.

Choice C reason: Cerebrovascular accident (CVA) is not the most likely condition for the client who has a severe headache, fever, nuchal rigidity, and a petechial rash on arms and legs. CVA is another term for stroke, which occurs when the blood supply to a part of the brain is interrupted, causing brain tissue damage. The rash is not a common sign of CVA, and the client may also have other symptoms such as facial drooping, slurred speech, difficulty swallowing, paralysis, and cognitive impairment.

Choice D reason: Meningococcal meningitis is the most likely condition for the client who has a severe headache, fever, nuchal rigidity, and a petechial rash on arms and legs. Meningococcal meningitis is a bacterial infection that causes inflammation of the membranes that cover the brain and spinal cord. The rash is a characteristic sign of meningococcal meningitis, which can appear as small red or purple spots that do not fade when pressed. The client may also have other symptoms such as nausea, vomiting, sensitivity to light, confusion, and seizures.