A nurse is collecting data from a client who has peripheral arterial disease (PAD). Which of the following findings should the nurse expect?
Warm extremities.
Darkened skin color near extremities.
Intermittent claudication.
Edema.
The Correct Answer is C
Choice A rationale
Warm extremities are not typically associated with peripheral arterial disease (PAD). PAD usually results in reduced blood flow, leading to cooler extremities.
Choice B rationale
Darkened skin color near extremities is more commonly associated with venous insufficiency rather than PAD. PAD typically causes pale or bluish skin due to reduced blood flow.
Choice C rationale
Intermittent claudication, which is pain or cramping in the legs during exercise that subsides with rest, is a hallmark symptom of PAD. It occurs due to reduced blood flow to the muscles during activity.
Choice D rationale
Edema is more commonly associated with venous insufficiency or heart failure rather than PAD. PAD typically causes reduced blood flow, not fluid accumulation.
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View Related questions
Correct Answer is C
Explanation
Choice A rationale
Cheyne-Stokes breathing is characterized by a pattern of periodic breathing with cycles of increasing and decreasing tidal volumes separated by periods of apnea. It is not typically associated with diabetic ketoacidosis (DKA) but rather with conditions such as heart failure, stroke, or brain injury.
Choice B rationale
Malignant hypertension is a severe form of high blood pressure that can lead to organ damage. It is not a typical finding in diabetic ketoacidosis. DKA is more commonly associated with dehydration, electrolyte imbalances, and metabolic acidosis.
Choice C rationale
An acetone odor to the breath is a classic sign of diabetic ketoacidosis. This occurs due to the accumulation of ketones in the blood, which are byproducts of fat metabolism when the body is unable to use glucose for energy.
Choice D rationale
Blood glucose levels below 40 mg/dL indicate hypoglycemia, not diabetic ketoacidosis. DKA is characterized by high blood glucose levels, typically above 250 mg/dL34.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A rationale
Obtaining the client’s weight is essential before hemodialysis to assess fluid status and determine the amount of fluid to be removed during the procedure. Accurate weight measurement helps in preventing complications such as hypotension or fluid overload.
Choice B rationale
Verifying the glomerular filtration rate (GFR) is important in assessing the kidney function of the client. GFR helps in determining the stage of chronic kidney disease and the appropriate dialysis regimen. It also aids in monitoring the effectiveness of the treatment.
Choice C rationale
Checking the graft site for a palpable thrill is crucial in assessing the patency of the vascular access used for hemodialysis. A palpable thrill indicates that the graft is functioning properly and allows for adequate blood flow during dialysis. Absence of a thrill may indicate a blockage or malfunction of the graft.
Choice D rationale
Documenting vital signs is a standard nursing practice before, during, and after hemodialysis. Monitoring vital signs helps in detecting any changes in the client’s condition, such as hypotension, hypertension, or arrhythmias, which may occur during the procedure. It ensures timely intervention and promotes client safety.
Choice E rationale
Administering a sedative to the client is not a standard practice for hemodialysis. Sedatives are generally not required for the procedure and may pose risks such as respiratory depression or altered mental status. The focus should be on providing comfort and reassurance to the client without the use of sedatives.