Question

The nurse is giving discharge instructions to a client with peripheral arterial disease. Which statement by the client indicates correct understanding of the chronic condition?

Answer 1

Correct Answers:

"I will walk slowly and progress steadily to 4 - 6 days a week. "

Rationale :

♦️Clients with Peripheral Arterial Disease (PAD) benefit from graded walking programs, as exercise promotes collateral circulation and improves oxygen delivery to ischemic tissues.

♦️Walking until mild pain (claudication) occurs, then resting and resuming once pain subsides, helps increase tolerance and decrease symptoms over time.

♦️Regular walking—30 to 45 minutes, 3–6 days a week—stimulates angiogenesis (formation of new vessels), enhancing lower extremity perfusion.

♦️Activities that improve circulation are emphasized, while elevation above heart level should be avoided because it reduces arterial flow.

♦️Patient education also includes smoking cessation, foot care, and avoiding tight clothing or cold exposure to improve outcomes.

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Answer 2

Correct Answers:

"Does the pain always occur when you walk that distance?"

Rationale :

🔷Intermittent claudication is a classic symptom of arterial insufficiency, characterized by cramping pain in the legs during exertion that subsides with rest.

🔷Asking if the pain always occurs after the same walking distance helps confirm that the pain is exercise-induced ischemia, not random or neuropathic pain.

🔷The symptom is caused by inadequate oxygen supply to working muscles due to narrowed arteries.

🔷Identifying this pattern assists in diagnosing Peripheral Arterial Disease (PAD) and in developing an appropriate exercise plan.

🔷Early recognition allows nurses to educate clients on supervised walking programs and risk factor modification.

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Answer 3

Correct Answers:

"Does the pain always occur when you walk that distance?"

Rationale :

🔷Intermittent claudication is a classic symptom of arterial insufficiency, characterized by cramping pain in the legs during exertion that subsides with rest.

🔷Asking if the pain always occurs after the same walking distance helps confirm that the pain is exercise-induced ischemia, not random or neuropathic pain.

🔷The symptom is caused by inadequate oxygen supply to working muscles due to narrowed arteries.

🔷Identifying this pattern assists in diagnosing Peripheral Arterial Disease (PAD) and in developing an appropriate exercise plan.

🔷Early recognition allows nurses to educate clients on supervised walking programs and risk factor modification.

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Answer 4

Correct Answers:

A client with poorly controlled Type 1 diabetes who is a smoker .

Rationale :

💠The ankle-brachial index (ABI) test measures the ratio of ankle to brachial systolic pressure to detect peripheral arterial disease (PAD).

💠Clients with diabetes and smoking history are at high risk for atherosclerosis and arterial occlusion due to endothelial damage.

💠ABI is indicated to assess degree of arterial obstruction, monitor disease progression, and guide treatment.

💠An ABI <0.9 confirms PAD; <0.4 indicates severe ischemia.

💠Early screening in diabetic smokers can prevent ulceration, gangrene, and amputation through timely intervention.

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Answer 5

Correct Answers:

"I will plan periods of rest with my legs elevated."

Rationale :

🔶After a Deep Vein Thrombosis (DVT), elevation of the legs helps promote venous return, reduce edema, and relieve discomfort.

🔶Elevation above heart level decreases venous pressure and prevents further clot extension.

🔶Prolonged immobility should be avoided—clients should alternate rest with gentle ambulation to support venous circulation.

🔶Compression stockings may be prescribed after the acute phase for long-term prevention of venous insufficiency.

🔶The client should also continue anticoagulant therapy as ordered and report any signs of bleeding or recurrence.

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Answer 6

Correct Answers:

Tarry stools

Rationale :

🟣Tarry or black stools (melena) indicate gastrointestinal bleeding, a serious complication of anticoagulant therapy such as warfarin or heparin.

🟣This results from over-anticoagulation leading to mucosal vessel bleeding within the GI tract.

🟣The nurse should instruct the patient to report any black, bloody, or coffee-ground stools immediately.

🟣Prompt evaluation includes checking prothrombin time (PT)/INR or aPTT depending on the drug and notifying the provider.

🟣Dose adjustments or administration of vitamin K (warfarin antidote) may be required to prevent hemorrhagic shock.

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Answer 7

Correct Answers:

Pulmonary embolism

Rationale :

🟣A pulmonary embolism (PE) occurs when a clot dislodges from the venous system (often from a DVT) and travels to the pulmonary arteries, obstructing blood flow.

🟣Symptoms include sudden dyspnea, diaphoresis, tachycardia, anxiety, and chest pain, often appearing abruptly.

🟣The situation is life-threatening and requires immediate response—oxygen administration, calling rapid response, and preparing for anticoagulation or thrombolytic therapy.

🟣Risk increases in patients with DVT, especially before procedures like vena cava filter insertion.

🟣Quick recognition and action can prevent cardiopulmonary collapse and death.

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Answer 8

Correct Answers:

"It is normal to have this feeling."

Rationale :

🔷The perception of the amputated limb still being present, known as phantom limb sensation, is a normal neurologic phenomenon following amputation.

🔷It results from continued nerve pathway activity and brain mapping of the missing limb.

🔷The nurse should validate the client’s feelings and provide reassurance that it is common and typically decreases over time.

🔷If painful, interventions include mirror therapy, desensitization, or medications such as gabapentin.

🔷Emotional support and education about normal adaptation aid the client’s psychological adjustment to limb loss.

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Answer 9

Correct Answers:

Pedal pulses

Rationale :

💠After a femoral-popliteal bypass graft, assessment of distal circulation is critical to determine graft patency and limb perfusion.

💠A drop in blood pressure from 128/60 to 90/60 may signify reduced graft flow or bleeding, requiring immediate evaluation of pedal pulses.

💠Absent or weak pulses may indicate graft occlusion, which is a surgical emergency.

💠Continuous monitoring of color, temperature, and capillary refill further confirms tissue perfusion.

💠Early detection allows timely surgeon notification and intervention to prevent ischemic loss.

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Answer 10

Correct Answers:

"It will get better and worse again."

Rationale :

🔶Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by periods of exacerbation and remission.

🔶Joint inflammation leads to pain, swelling, and stiffness, especially in the morning or after inactivity.

🔶The disease course is unpredictable, with flare-ups followed by intervals of symptom improvement.

🔶The nurse should teach the client about medication adherence, joint protection, and energy conservation to manage symptoms effectively.

🔶Emotional support is important, as RA affects both physical function and quality of life.

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N210_Fall_2023_Exam_2_DAY-EVE_Fundamentals

No.

1 :
The nurse is giving discharge instructions to a client with peripheral arterial disease. Which statement by the client indicates correct understanding of the chronic condition?

2 :
A client admitted for arterial insufficiency complains of pain when walking five blocks. Which question is the best for the nurse to ask to determine if the client is experiencing intermittent claudication?

3 :
A client admitted for arterial insufficiency complains of pain when walking five blocks. Which question is the best for the nurse to ask to determine if the client is experiencing intermittent claudication?

4 :
A nurse has admitted four clients over the course of a 12 hour shift. For which client would assessment of ankle brachial index be most clearly warranted?

5 :
A 50 year old patient with an occupation as a hairdresser was hospitalized for deep vein thrombosis. The nurse initiates the teaching plan prior to discharge. Which statement made by the patient reflects that discharge teaching has been effective?

6 :
A patient is receiving anticoagulant therapy for deep vein thrombosis (DVT). What report made by the patient would the nurse be most concerned with?

7 :
A patient scheduled for insertion of a vena cava filter begins to become diaphoretic and complains of shortness of breath. What should the nurse recognize these ominous clinical manifestations as?

8 :
After the amputation of his leg, a client tells the nurse that he can still feel his missing leg. Which response by the nurse is most appropriate?

9 :
A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft. The blood pressure has decreased from 128/60 to 90/60. What should the nurse assess first?

10 :
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

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N210_Fall_2023_Exam_2_DAY-EVE_Fundamentals

No.

1 : The nurse is giving discharge instructions to a client with peripheral arterial disease. Which statement by the client indicates correct understanding of the chronic condition?

2 : A client admitted for arterial insufficiency complains of pain when walking five blocks. Which question is the best for the nurse to ask to determine if the client is experiencing intermittent claudication?

3 : A client admitted for arterial insufficiency complains of pain when walking five blocks. Which question is the best for the nurse to ask to determine if the client is experiencing intermittent claudication?

4 : A nurse has admitted four clients over the course of a 12 hour shift. For which client would assessment of ankle brachial index be most clearly warranted?

5 : A 50 year old patient with an occupation as a hairdresser was hospitalized for deep vein thrombosis. The nurse initiates the teaching plan prior to discharge. Which statement made by the patient reflects that discharge teaching has been effective?

6 : A patient is receiving anticoagulant therapy for deep vein thrombosis (DVT). What report made by the patient would the nurse be most concerned with?

7 : A patient scheduled for insertion of a vena cava filter begins to become diaphoretic and complains of shortness of breath. What should the nurse recognize these ominous clinical manifestations as?

8 : After the amputation of his leg, a client tells the nurse that he can still feel his missing leg. Which response by the nurse is most appropriate?

9 : A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft. The blood pressure has decreased from 128/60 to 90/60. What should the nurse assess first?

10 : A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

1 :
The nurse is giving discharge instructions to a client with peripheral arterial disease. Which statement by the client indicates correct understanding of the chronic condition?

2 :
A client admitted for arterial insufficiency complains of pain when walking five blocks. Which question is the best for the nurse to ask to determine if the client is experiencing intermittent claudication?

3 :
A client admitted for arterial insufficiency complains of pain when walking five blocks. Which question is the best for the nurse to ask to determine if the client is experiencing intermittent claudication?

4 :
A nurse has admitted four clients over the course of a 12 hour shift. For which client would assessment of ankle brachial index be most clearly warranted?

5 :
A 50 year old patient with an occupation as a hairdresser was hospitalized for deep vein thrombosis. The nurse initiates the teaching plan prior to discharge. Which statement made by the patient reflects that discharge teaching has been effective?

6 :
A patient is receiving anticoagulant therapy for deep vein thrombosis (DVT). What report made by the patient would the nurse be most concerned with?

7 :
A patient scheduled for insertion of a vena cava filter begins to become diaphoretic and complains of shortness of breath. What should the nurse recognize these ominous clinical manifestations as?

8 :
After the amputation of his leg, a client tells the nurse that he can still feel his missing leg. Which response by the nurse is most appropriate?

9 :
A client with peripheral vascular disease has undergone a right femoral-popliteal bypass graft. The blood pressure has decreased from 128/60 to 90/60. What should the nurse assess first?

10 :
A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?