A nurse is assessing client with advanced peripheral arterial disease (PAD). Which of the following findings would the nurse expect?
Shiny, hairless lower extremities.
Warm lower extremities.
Thin toenails.
Lower extremity bilateral pulse 3+
The Correct Answer is A
A) Shiny, hairless lower extremities: In advanced peripheral arterial disease (PAD), the skin on the lower extremities often appears shiny and hairless due to reduced blood flow. The lack of hair growth and the shiny appearance are indicative of ischemia and poor circulation, making this a common finding in clients with advanced PAD.
B) Warm lower extremities: This finding is not typical in advanced PAD. Due to compromised blood flow, the lower extremities are more likely to feel cool or cold to the touch rather than warm. Warm skin can indicate good blood flow, which is usually absent in cases of significant arterial disease.
C) Thin toenails: In advanced PAD, toenails may become thin and brittle due to insufficient blood supply, which can lead to impaired nail growth. This change is consistent with the overall effects of reduced circulation and is an expected finding in clients with advanced PAD.
D) Lower extremity bilateral pulse 3+: A 3+ pulse indicates a strong and bounding pulse, which is not typically present in advanced PAD. In fact, patients with PAD often exhibit diminished or absent pulses in the affected extremities due to poor arterial circulation. Therefore, this finding does not align with the expected assessment results for advanced PAD.
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Correct Answer is ["A","B","C","D"]
Explanation
A) "I will apply my compression stockings." Compression stockings are a standard recommendation for clients with peripheral venous disease (PVD). They help improve venous return and reduce symptoms like swelling and discomfort, indicating that the client understands the importance of managing their condition.
B) "I will limit long periods of standing." This statement reflects an understanding of the need to avoid activities that can exacerbate venous stasis and contribute to worsening symptoms in PVD. Limiting long periods of standing helps promote better blood flow and reduces the risk of complications.
C) "I may develop a brownish discoloration to my lower extremities." This statement indicates an awareness of a potential complication of PVD, often caused by venous stasis and pooling of blood. Brownish discoloration, or stasis dermatitis, can occur in the lower extremities, showing the client’s understanding of the condition.
D) "With this problem, I may have lower extremity hair loss." This statement is accurate as well; hair loss on the lower extremities can occur with PVD due to reduced blood flow and oxygen supply to the tissues. This recognition indicates that the client understands the potential effects of their diagnosis.
E) "I will only take my cholesterol lowering medication every other day in the afternoon." This statement reflects a misunderstanding of medication management. Clients with PVD should take prescribed medications as directed to manage their condition effectively, and altering the dosing schedule without consulting a healthcare provider can lead to adverse outcomes.
Correct Answer is C
Explanation
A) Apply cold therapy to the affected leg: Cold therapy may be used for certain conditions to reduce swelling and pain, but in the case of suspected deep vein thrombosis (DVT) indicated by redness, warmth, tenderness, and pain in the calf, cold therapy is not appropriate. Instead, the focus should be on confirming the diagnosis before applying any treatment.
B) Monitor Homan's sign: Homan's sign involves dorsiflexion of the foot to assess for pain in the calf, which can suggest DVT. However, it is no longer considered a reliable diagnostic tool. Instead, confirmation through imaging or other diagnostic measures is preferred, so simply monitoring this sign would not be sufficient in this situation.
C) Obtain a venous duplex ultrasound: A venous duplex ultrasound is the gold standard for
diagnosing DVT. Given the client’s symptoms—redness, warmth, tenderness, and pain in the calf—the appropriate order is to obtain this ultrasound to confirm the presence of a thrombus. This imaging study provides critical information for diagnosis and subsequent management.
D) Obtain impedance plethysmography: While impedance plethysmography can assess venous flow and help diagnose DVT, it is less commonly used than venous duplex ultrasound. The more direct and widely accepted method for diagnosing DVT in this scenario is the ultrasound, making this option less suitable as the initial order.