Med Surg Hesi exam with correct |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
answers
The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The client, who exercises regularly, reports having pain in the calf during exercise that
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
disappears at rest. Which of the following findings requires further evaluation? |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
1. Heart rate 57 bpm.
|||\\\ |||\\\ |||\\\ |||\\\
2. SpO2 of 94% on room air.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
3. Blood pressure 134/82.
|||\\\ |||\\\ |||\\\
4. Ankle-brachial index of 0.65. - correct answer✔✔4
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
An Ankle-Brachial Index of 0.65 suggests moderate arterial vascular disease in a client who is
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
experiencing intermittent claudication. A Doppler ultrasound is |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
indicated for further evaluation. The bradycardic heart rate is acceptable in an athletic client
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
with a normal blood pressure. The SpO2 is acceptable; the client has a smoking history.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
An overweight client taking warfarin (Coumadin) has dry skin due to decreased arterial blood
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
flow. What should the nurse instruct the client to do? Select all that apply.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
1. Apply lanolin or petroleum jelly to intact skin.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
2. Follow a reduced-calorie, reduced-fat diet.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
3. Inspect the involved areas daily for new ulcerations.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
4. Instruct the client to limit activities of daily living (ADLs).
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
5.Use an electric razor to shave - correct answer✔✔1,2,3,5
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,Maintaining skin integrity is important in preventing chronic ulcers and infections. The client |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
should be taught to inspect the skin on a daily basis. The client
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
should reduce weight to promote circulation; a diet lower in calories and fat is appropriate.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Because the client is receiving Coumadin, the client is at risk for bleeding from cuts. To
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
decrease the risk of cuts, the nurse should suggest that the client use an electric razor. The
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
client with decreased arterial blood flow should be encouraged to participate in ADLs. In fact,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
the client should be encouraged to consult an exercise
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
physiologist for an exercise program that enhances the aerobic capacity of the body. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The blood pressure has decreased from 124/80 to 94/62. What should the nurse assess first?
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
1. IV fluid solution.
|||\\\ |||\\\ |||\\\
2. Pedal pulses.
|||\\\ |||\\\
3. Nasal cannula flow rate.
|||\\\ |||\\\ |||\\\ |||\\\
4. Capillary refill - correct answer✔✔2
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
With each set of vital signs, the nurse should assess the dorsalis pedis and posterior tibial
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
pulses. The nurse needs to ensure adequate perfusion to the lower
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
extremity with the drop in blood pressure. IV fluids, nasal cannula setting, and capillary refill |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
are important to assess; however, priority is to determine the cause of drop in blood pressure
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
and that adequate perfusion through the new graft is maintained.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The nurse is caring for a client with peripheral artery disease who has recently been prescribed
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
clopidogrel (Plavix). The nurse understands that more teaching is necessary when the client |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
states which of the following: |||\\\ |||\\\ |||\\\ |||\\\
1. "I should not be surprised if I bruise easier or if my gums bleed a little when
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
brushing my teeth." |||\\\ |||\\\
2. "It doesn't really matter if I take this medicine with or without food, whatever
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
works best for my stomach." |||\\\ |||\\\ |||\\\ |||\\\
,3. "I should stop taking Plavix if it makes me feel weak and dizzy."
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
4. "The doctor prescribed this medicine to make my platelets less likely to stick together and
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
help prevent clots from forming." - correct answer✔✔3
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Weakness, dizziness, and headache are common adverse effects of Plavix and the client should |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
report these to the physician if they are problematic; in order to decrease risk of clot
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
formation, Plavix must be taken regularly and should not be stopped or taken intermittently. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The main adverse effect of Plavix is bleeding, which often occurs as increased bruising or
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
bleeding when brushing teeth. Plavix is well absorbed, and while food may help decrease
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
potential gastrointestinal upset, Plavix may be taken with or without food. Plavix is an |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
antiplatelet agent used to prevent clot formation in clients who have experienced or are at risk |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
syndrome.
A client is receiving Cilostazol (Pletal) for peripheral arterial disease causing intermittent
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
claudication. The nurse determines this medication is effective when the client reports which of |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
the following?
|||\\\ |||\\\
1. "I am having fewer aches and pains."
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
2. "I do not have headaches anymore."
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
3. "I am able to walk further without leg pain."
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
4. "My toes are turning grayish black in color." - correct answer✔✔3
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Cilostazol is indicated for management of intermittent claudication. Symptoms usually improve |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
within 2 to 4 weeks of therapy. Intermittent claudication prevents
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
clients from walking for long periods of time. Cilostazol inhibits platelet aggregation induced by
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
various stimuli and improving blood flow to the muscles and allowing the client to walk long
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
distances without pain. Peripheral arterial disease causes pain mainly of the leg muscles. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
"Aches and pains" does not specify exactly where the pain is occurring. Headaches may occur
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
as a side effect of this drug, and the client should report this information to the health care
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
provider. Peripheral arterial disease causes decreased blood supply to the peripheral tissues
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
, and may cause gangrene of the toes; the drug is effective when the toes are warm to the touch
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
and the color of the toes is similar to the color of the body.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The client admitted with peripheral vascular disease (PVD) asks the nurse why her legs hurt
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
when she walks. The nurse bases a response on the knowledge that the main characteristic of
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
PVD is: |||\\\
1. Decreased blood flow.
|||\\\ |||\\\ |||\\\
2. Increased blood flow.
|||\\\ |||\\\ |||\\\
3. Slow blood flow.
|||\\\ |||\\\ |||\\\
4. Thrombus formation. - correct answer✔✔1
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Decreased blood flow is a common characteristic of all PVD. When the demand for oxygen to |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
the working muscles becomes greater than the supply, pain is the
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
outcome. Slow blood flow throughout the circulatory system may suggest pump failure. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Thrombus formation can result from stasis or damage to the intima of the vessels. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The nurse is planning care for a client who is diagnosed with peripheral vascular disease (PVD)
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
and has a history of heart failure. The nurse should develop a plan of care that is based on the
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
fact that the client may have a low tolerance for exercise related to:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
1. Decreased blood flow.
|||\\\ |||\\\ |||\\\
2. Increased blood flow.
|||\\\ |||\\\ |||\\\
3. Decreased pain.
|||\\\ |||\\\
4. Increased blood viscosity. - correct answer✔✔1
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
A client with PVD and heart failure will experience decreased blood flow. In this situation, low
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
exercise tolerance (oxygen demand becomes greater than the oxygen supply) may be related to
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
less blood being ejected from the left ventricle into the systemic circulation. Decreased blood
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
supply to the tissues results in pain. Increased blood viscosity may be a component, but it is of
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
much less importance than the disease processes.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
answers
The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The client, who exercises regularly, reports having pain in the calf during exercise that
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
disappears at rest. Which of the following findings requires further evaluation? |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
1. Heart rate 57 bpm.
|||\\\ |||\\\ |||\\\ |||\\\
2. SpO2 of 94% on room air.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
3. Blood pressure 134/82.
|||\\\ |||\\\ |||\\\
4. Ankle-brachial index of 0.65. - correct answer✔✔4
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
An Ankle-Brachial Index of 0.65 suggests moderate arterial vascular disease in a client who is
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
experiencing intermittent claudication. A Doppler ultrasound is |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
indicated for further evaluation. The bradycardic heart rate is acceptable in an athletic client
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
with a normal blood pressure. The SpO2 is acceptable; the client has a smoking history.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
An overweight client taking warfarin (Coumadin) has dry skin due to decreased arterial blood
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
flow. What should the nurse instruct the client to do? Select all that apply.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
1. Apply lanolin or petroleum jelly to intact skin.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
2. Follow a reduced-calorie, reduced-fat diet.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
3. Inspect the involved areas daily for new ulcerations.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
4. Instruct the client to limit activities of daily living (ADLs).
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
5.Use an electric razor to shave - correct answer✔✔1,2,3,5
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,Maintaining skin integrity is important in preventing chronic ulcers and infections. The client |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
should be taught to inspect the skin on a daily basis. The client
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
should reduce weight to promote circulation; a diet lower in calories and fat is appropriate.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Because the client is receiving Coumadin, the client is at risk for bleeding from cuts. To
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
decrease the risk of cuts, the nurse should suggest that the client use an electric razor. The
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
client with decreased arterial blood flow should be encouraged to participate in ADLs. In fact,
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
the client should be encouraged to consult an exercise
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
physiologist for an exercise program that enhances the aerobic capacity of the body. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The blood pressure has decreased from 124/80 to 94/62. What should the nurse assess first?
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
1. IV fluid solution.
|||\\\ |||\\\ |||\\\
2. Pedal pulses.
|||\\\ |||\\\
3. Nasal cannula flow rate.
|||\\\ |||\\\ |||\\\ |||\\\
4. Capillary refill - correct answer✔✔2
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
With each set of vital signs, the nurse should assess the dorsalis pedis and posterior tibial
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
pulses. The nurse needs to ensure adequate perfusion to the lower
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
extremity with the drop in blood pressure. IV fluids, nasal cannula setting, and capillary refill |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
are important to assess; however, priority is to determine the cause of drop in blood pressure
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
and that adequate perfusion through the new graft is maintained.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The nurse is caring for a client with peripheral artery disease who has recently been prescribed
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
clopidogrel (Plavix). The nurse understands that more teaching is necessary when the client |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
states which of the following: |||\\\ |||\\\ |||\\\ |||\\\
1. "I should not be surprised if I bruise easier or if my gums bleed a little when
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
brushing my teeth." |||\\\ |||\\\
2. "It doesn't really matter if I take this medicine with or without food, whatever
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
works best for my stomach." |||\\\ |||\\\ |||\\\ |||\\\
,3. "I should stop taking Plavix if it makes me feel weak and dizzy."
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
4. "The doctor prescribed this medicine to make my platelets less likely to stick together and
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
help prevent clots from forming." - correct answer✔✔3
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Weakness, dizziness, and headache are common adverse effects of Plavix and the client should |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
report these to the physician if they are problematic; in order to decrease risk of clot
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
formation, Plavix must be taken regularly and should not be stopped or taken intermittently. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The main adverse effect of Plavix is bleeding, which often occurs as increased bruising or
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
bleeding when brushing teeth. Plavix is well absorbed, and while food may help decrease
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
potential gastrointestinal upset, Plavix may be taken with or without food. Plavix is an |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
antiplatelet agent used to prevent clot formation in clients who have experienced or are at risk |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
for myocardial infarction, ischemic stroke, peripheral artery disease, or acute coronary
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
syndrome.
A client is receiving Cilostazol (Pletal) for peripheral arterial disease causing intermittent
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
claudication. The nurse determines this medication is effective when the client reports which of |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
the following?
|||\\\ |||\\\
1. "I am having fewer aches and pains."
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
2. "I do not have headaches anymore."
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
3. "I am able to walk further without leg pain."
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4. "My toes are turning grayish black in color." - correct answer✔✔3
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Cilostazol is indicated for management of intermittent claudication. Symptoms usually improve |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
within 2 to 4 weeks of therapy. Intermittent claudication prevents
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clients from walking for long periods of time. Cilostazol inhibits platelet aggregation induced by
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various stimuli and improving blood flow to the muscles and allowing the client to walk long
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distances without pain. Peripheral arterial disease causes pain mainly of the leg muscles. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
"Aches and pains" does not specify exactly where the pain is occurring. Headaches may occur
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as a side effect of this drug, and the client should report this information to the health care
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provider. Peripheral arterial disease causes decreased blood supply to the peripheral tissues
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, and may cause gangrene of the toes; the drug is effective when the toes are warm to the touch
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and the color of the toes is similar to the color of the body.
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The client admitted with peripheral vascular disease (PVD) asks the nurse why her legs hurt
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when she walks. The nurse bases a response on the knowledge that the main characteristic of
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PVD is: |||\\\
1. Decreased blood flow.
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2. Increased blood flow.
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3. Slow blood flow.
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4. Thrombus formation. - correct answer✔✔1
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Decreased blood flow is a common characteristic of all PVD. When the demand for oxygen to |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
the working muscles becomes greater than the supply, pain is the
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outcome. Slow blood flow throughout the circulatory system may suggest pump failure. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Thrombus formation can result from stasis or damage to the intima of the vessels. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
The nurse is planning care for a client who is diagnosed with peripheral vascular disease (PVD)
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and has a history of heart failure. The nurse should develop a plan of care that is based on the
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fact that the client may have a low tolerance for exercise related to:
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1. Decreased blood flow.
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2. Increased blood flow.
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3. Decreased pain.
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4. Increased blood viscosity. - correct answer✔✔1
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A client with PVD and heart failure will experience decreased blood flow. In this situation, low
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exercise tolerance (oxygen demand becomes greater than the oxygen supply) may be related to
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less blood being ejected from the left ventricle into the systemic circulation. Decreased blood
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supply to the tissues results in pain. Increased blood viscosity may be a component, but it is of
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much less importance than the disease processes.
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