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Exam (elaborations) MED SURGIC 324 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.$32.49
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Exam (elaborations) MED SURGIC 324 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.
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Course
MED SURGIC 324
Institution
Chamberlain College Of Nursing
Exam (elaborations) MED SURGIC 324 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 nurse would question her about a amount of activity required to cause pain
exam elaborations med surgic
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Chamberlain College Of Nursing
MED SURGIC 324
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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
d. pitting edema of the lower extremities.
, 2
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.
The ultrasonic duplex scanner is used to localize vascular obstruction, evaluate the degree of stenosis, and
determine the presence or absence of vascular reflux. It is also the most sensitive and specific non-
invasive test for detecting DVT.
1. During a physical exam, the nurse asks the client about medical problems that can impact
vascular health, including (Select all that apply)
a. diabetes.
, 3
b. heart disease.
c. stroke or TIA.
e. prior frostbite.
The nurse should specifically question the client about hypertension, diabetes, stroke, TIAs, changes in
vision, phlebitis, history of blood clots, pulmonary emboli, varicose veins, or a previous history of
frostbite.
2. Age-related changes the nurse incorporates into interpreting the physical assessment for
vascular disorders include (Select all that apply)
b. dorsalis pedis and posterior tibial pulses may be more difficult to palpate.
c. peripheral vascular disease is common among the elderly.
Atherosclerosis and peripheral vascular disease are both more common in the elderly population. Also, the
dorsalis pedis and posterior tibial pulses may be more difficult to palpate. Blood pressure readings should
not be inaccurate in older people, and dependent rubor is not seen in older clients in the absence of venous
disorders.
1. When a client diagnosed with primary hypertension asks the nurse what causes this disease,
the nurse’s best response would be “High blood pressure is caused by
b. a number of factors, not just one cause.”
Primary hypertension results from an array of genetic and environmental factors.
2. The nurse would explain to a client that the most common cause of secondary hypertension
is
a. chronic renal disease.
Chronic renal disease, mainly chronic glomerulonephritis and renal artery stenosis, is the most common
cause of secondary hypertension.
3. A hypertensive client, age 55, is slightly obese, has a sedentary lifestyle, and smokes half a
pack of cigarettes daily. For the behavioral change with the most immediate and positive
impact on his blood pressure, the nurse would focus on
d. weight reduction measures.
, 4
The relationship between obesity and blood pressure has been clearly established from numerous studies.
For many people with hypertension whose body weight is more than 10% over ideal, weight reduction of
as little as 10 pounds can lower blood pressure. Also weight loss may improve the response to medication.
4. In advising a hypertensive client who is reluctant to give up smoking, the nurse would state
that nicotine from smoking
c. increases blood pressure immediately for a short time.
Although smoking has not been statistically linked to the development of hypertension, nicotine causes
peripheral vasoconstriction, which raises the blood pressure for a short time. It also increases the risk of
cardiovascular disease, stroke, and cancer.
5. When a client tells the nurse, “I heard that potassium supplements are effective in treating
hypertension,” the nurse’s most appropriate reply would be as follows:
c. “You can achieve the same benefits from low-sodium, high-potassium foods.”
Reducing intake of high-sodium, low-potassium processed foods and increasing intake of low-sodium,
high-potassium natural foods may be sufficient to achieve the potential benefits. Potassium supplements
are also too costly and potentially too hazardous for routine use.
6. The nurse working with hypertensive clients knows that what factor is most important in
order for the client’s treatment plan to be successful?
c. Long-term compliance and adherence to therapy
Long-term compliance and adherence has emerged as the most essential element in reducing morbidity
and mortality associated with hypertension. Noncompliance is often due to client beliefs and values that
conflict with the treatment plan. The plan must be mutually designed by health care providers and the
client. Referrals to the interdisciplinary team are important, as is provider willingness to change
medications if side effects are intolerable, but the single most important determinant of success is
compliance and adherence.
7. In conducting a health interview with a hypertensive client, the nurse would ask the client
about the presence of the typical manifestations of the disorder, which are
c. none unless the hypertension is sustained.
Typically the hypertensive client has no manifestations, which contributes to noncompliance. If the
disorder goes undiagnosed, eventually the blood pressure will rise high enough to cause persistent
headaches, fatigue, dizziness, palpitations, flushing, blurred or double vision, or epistaxis.
8. An African-American male is being started on medication for hypertension, and the
physician has prescribed a beta blocker as first-line therapy. The most appropriate action by
the nurse is to
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