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 A
Explanation
Choice A rationale
Serving cooked fruit with meals is an appropriate intervention for a client with a low WBC count after chemotherapy. Cooking fruit helps eliminate potential pathogens, reducing the risk of infection.
Choice B rationale
Reporting temperatures greater than 39.5°C (102.3°F) lasting more than 4 hours is not appropriate. A lower threshold for fever should be used, as even a slight increase in temperature can indicate infection in immunocompromised clients.
Choice C rationale
Placing the client in a room with negative-pressure airflow is not necessary for clients with low WBC counts. This intervention is typically used for clients with airborne infections.
Choice D rationale
Instructing the client to use an incentive spirometer every 4 hours is beneficial for lung health but does not directly address the risk of infection associated with low WBC counts. .
Correct Answer is B
Explanation
Choice A rationale
Using several different scales to obtain the weight is incorrect. Consistency is key when monitoring weight, especially for clients with chronic kidney disease. Using the same scale ensures that weight measurements are accurate and comparable over time. Different scales may have slight variations, leading to inconsistent and unreliable data.
Choice B rationale
Weighing at the same time each day is correct. It is important to weigh at the same time each day, preferably in the morning after voiding and before eating, to obtain consistent and accurate measurements. This helps in monitoring fluid retention and changes in body weight, which are critical for managing chronic kidney disease.
Choice C rationale
Calibrating weight scales every week is not necessary. While it is important to ensure that the scale is accurate, weekly calibration is excessive. Regular calibration according to the manufacturer’s instructions or as needed is sufficient to maintain accuracy. Over-calibration can be time-consuming and may not significantly improve measurement accuracy.
Choice D rationale
Measuring weight just prior to voiding is incorrect. Weighing after voiding provides a more accurate measurement of body weight without the influence of bladder contents. This is especially important for clients with chronic kidney disease, as fluid balance and retention are closely monitored.