MED SURG 324 Exam 2- Final Review

1. When a female client tells the nurse, “I always get pains in my legs when walking,” the nurse would question her about a. amount of activity required to cause pain. The extent of the disease can be gauged by the distance the client is able to walk without pain, or the “claudication” distance. 2. For a client admitted to the hospital with chronic venous disease, the nurse’s assessment of the client’s legs would most likely reveal b. erythema. Initial skin changes noted with chronic venous disorders may include erythema (redness), followed in later stages by lipodermatosclerosis (brawny, thick, darkly pigmented skin). Decreased pulses would indicate an arterial disorder. 3. A client with venous disease is scheduled for impedance plethysmography. Before the study the nurse would explain that c. venous blood flow quality will be measured. Impedance plethysmography is used to measure venous blood volume changes in the extremities. Electrodes and a pressure cuff are attached to an extremity. As the pressure cuff is inflated and electrical resistance increases, the quality of venous blood flow can be demonstrated. This non-invasive test does not use dye, does not require walking on a treadmill, nor is it uncomfortable. 4. To determine if a client with complaints of pain after walking 5 blocks is experiencing intermittent claudication, the nurse would ask b. “Does pain go away when you rest?” Initially the pain of claudication is consistent and develops after a fixed amount of activity (e.g., walking around the block) and disappears within 1-2 minutes of resting. 5. When assessing a client with arterial insufficiency, the nurse would expect b. cool, pale skin. Hallmarks of arterial insufficiency include decreased or absent pulses; possible systolic bruit over involved arteries; muscular atrophy; thin, shiny, hairless skin; thick, ridged toenails; cool skin temperature; and ulcers on pressure points of feet. 6. During lower extremity inspection of a client with early chronic venous disease, the nurse would expect to find 2 d. pitting edema of the lower extremities. In more severe forms of chronic venous disorders, lower extremity edema is the usual initial complaint. Pitting edema may be seen at first, but as the edema becomes more chronic, scarring develops and the pitting disappears. 7. The nurse tests the capillary refill on a client’s lower extremity and notes that it takes 4 seconds for the color to return to baseline. It would be most important for the nurse to then check for b. other indicators of peripheral perfusion. Capillary refill time is an evaluation of peripheral perfusion and cardiac output. Normal is up to 3 seconds; 4 seconds is too slow, so the nurse should do further assessments of peripheral perfusion. Certainly constrictive clothing might be a problem, but that would be considered as part of the peripheral perfusion assessment. Venous ulceration is also part of an assessment of peripheral perfusion. 8. A client is taking garlic and hawthorn supplements. The nurse would ask further questions to elicit information on a possible history of b. hypertension. Herbal preparations that are used to self-treat hypertension include garlic, hawthorn, kudzu, nettle, onion, purslane, reishi mushrooms, and valerian. 9. A client has a 30 mm Hg difference in blood pressures in the arms. For subsequent blood pressure readings, the nurse should use c. the arm with the higher reading. difference in blood pressure of 20 mm Hg or more may indicate other medical problems. This discrepancy should be documented. The nurse should use the arm with the higher reading for all subsequent blood pressure measurements. 10. A client has a suspected DVT. The nurse would prepare the client to undergo a d. ultrasonic duplex scan.