The nurse is caring for a client with weak pedal pulses, absent hair on bilateral legs, and a full-thickness wound on the right lateral malleolus with defined margins, including a minimal amount of serous exudate.
Which of the following interventions is contraindicated?
Assess the need for smoking cessation.
Apply TED hose to bilateral legs.
Consult physical therapy.
Obtain Ankle-Brachial Index (ABI) with a hand-held Doppler.
The Correct Answer is B
Choice A rationale
Assessing the need for smoking cessation is a standard part of nursing care, especially for patients with circulatory issues. Smoking can exacerbate circulatory problems and delay wound healing.
Choice B rationale
Applying TED hose to bilateral legs might not be appropriate for this patient. TED hose are compression stockings designed to prevent deep vein thrombosis and promote circulation.
However, in a patient with weak pedal pulses and a full-thickness wound on the leg, the compression from the stockings could potentially worsen circulation to the area and impede wound healing.
Choice C rationale
Consulting physical therapy could be beneficial for this patient. Physical therapists can provide exercises and interventions to improve circulation and mobility, which could help with the patient’s circulatory issues and wound healing.
Choice D rationale
Obtaining an Ankle-Brachial Index (ABI) with a hand-held Doppler could be useful in this situation. The ABI is a simple, non-invasive test that can help diagnose peripheral artery disease (PAD), a condition that could be causing the patient’s weak pedal pulses and wound healing issues.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
While obesity can contribute to hypertension and other cardiovascular diseases, it is not a contraindication for the use of propranolol. Weight management would be part of the overall treatment plan for hypertension, but it would not prevent the use of this medication.
Choice B rationale
Age is not a contraindication for the use of propranolol. While older adults may be more susceptible to certain side effects of the medication, age alone would not prevent a patient from taking propranolol.
Choice C rationale
Diabetes is a contraindication for the use of propranolol. Propranolol is a non-selective beta- blocker, which can mask symptoms of hypoglycemia, a common condition in people with diabetes. Therefore, it’s generally not recommended for people with diabetes.
Choice D rationale
Race is not a contraindication for the use of propranolol. While there are some differences in how people of different races may respond to certain medications, race alone would not prevent a patient from taking propranolol.
Correct Answer is C
Explanation
Choice A rationale
Daily alcohol use is not a direct contraindication for Propranolol (Inderal), but it’s important to note that alcohol can increase the blood pressure-lowering effect of propranolol, which can make you feel dizzy or lightheaded.
Choice B rationale
Propranolol is often used in the treatment of conditions related to heart disease, such as hypertension and angina, and it can also be used in the secondary prevention of myocardial infarction.
Choice C rationale
Asthma is a contraindication for the use of Propranolol (Inderal). Propranolol can cause bronchial constriction by blocking beta-adrenergic receptors in the lungs, which can exacerbate asthma symptoms.
Choice D rationale
Peptic ulcer disease is not a direct contraindication for Propranolol (Inderal). However, like any medication, Propranolol should be used with caution in patients with a history of peptic ulcer disease.
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