Adherence/Perfusion(Bonus)

The clinic nurse is teaching an adolescent about lifestyle modifications to prevent hyperlipidemia. Which statement by the adolescent indicates a need for further teaching? 1 "I'll start eating more red meat." 2 "I'm going to eat a lot of low-fat yogurt." 3 "I'll try to stop eating so much processed food." 4 "I'll start eating whole-grain bread instead of white."

1 "I'll start eating more red meat." Red meats are high in fat. The monounsaturated and polyunsaturated fats can increase high density lipoprotein and decrease low density lipoprotein cholesterol. For this reason, an increase in the consumption of red meat is not advisable. Most whole grains, breads, pastas, and cereals are naturally low in fat. Adolescents should be taught to choose lean meats, beans, and low-fat dairy products and to limit their intake of processed foods such as crackers, cookies, cakes, and higher fat snacks.

When assessing the client with peripheral arterial disease, the nurse anticipates the presence of which clinical manifestations? Select all that apply. 1 Dependent rubor 2 Warm extremities 3 Ulcers on the toes 4 Thick, hardened skin 5 Delayed capillary refill

1. Dependent rubor 3. Ulcers on the toes 5. Delayed capillary refill Peripheral arterial disease affects arterial circulation and results in delayed and impaired circulation to the extremities. As a result, the extremities exhibit rubor while in the dependent position and pallor while elevated, ulcers on the feet and toes, cool skin, and capillary refill longer than three seconds. Warm extremities and thick, hardened skin occur in the presence of venous disease.

A nurse is teaching a health class about heart disease to older adult women. The nurse discusses the most common prodromal symptom reported by women with acute coronary heart disease that usually is not experienced by men. Which response indicates a woman in the group understands the teaching? 1 Unusual fatigue 2 Shortness of breath 3 Crushing pain in the chest 4 Substernal pressure radiating to the neck

1. Unusual fatigue Studies indicate that women who have myocardial infarctions frequently experience unusual prodromal fatigue; also, during the prodromal period, women more frequently experience upper abdominal fullness instigated by exertion or emotional stress. Substernal pressure that radiates to the neck is experienced more often by men than by women during the acute period of a myocardial infarction. Although women do experience the other symptoms, they do not occur as frequently as fatigue.

The nurse recognizes that which are important components of a neurovascular assessment? Select all that apply. 1 Orientation 2 Capillary refill 3 Pupillary response 4 Respiratory rate 5 Pulse and skin temperature 6 Movement and sensation

2. Capillary refill 5. Pulse and skin temperature 6. Movement and sensation A neurovascular assessment involves evaluation of nerve and blood supply to an extremity involved in an injury. The area involved may include an orthopedic or soft tissue injury. A correct neurovascular assessment should include evaluation of capillary refill, pulses, warmth and paresthesias, and movement and sensation. Orientation, pupillary response, and respiratory rate are components of a neurologic assessment.

Which condition will the nurse monitor for in a client with interruption of venous return? 1 Tenting 2 Varicosity 3 Petechiae 4 Ecchymosis

2. Varicosity Varicosity is the interruption of venous return that will cause a bulge and prominence of superficial veins. Tenting is the failure of skin to return immediately to normal position after gentle pinching, which occurs because of aging, dehydration, and cachexia. Petechiae are flat, pinpoint (<1 to 2 mm in size), discrete deposits of blood found on the extravascular tissues that result from decreased platelet count in blood. Ecchymosis is a small, bruise-like lesion, larger than a petechia, caused by the collection of extravascular blood in the dermis and subcutaneous tissue that occurs due to trauma and bleeding disorders.

Which clinical condition will result in changes in the integrity of the arterial walls and small blood vessels? 1 Contusion 2 Thrombosis 3 Atherosclerosis 4 Tourniquet effect

3. Atherosclerosis In atherosclerosis, there may be changes in the integrity of the walls of the arteries and smaller blood vessels. Direct manipulation of vessels or localized edema that impairs blood flow will lead to a contusion. Blood clotting that causes mechanical obstruction to blood flow indicates thrombosis. The tourniquet effect may be caused by the application of constricting devices, which may lead to impaired blood flow to areas below the site of constriction.

The nurse is caring for a client who has an occlusion of the left femoral artery and is scheduled for an arteriogram. Which clinical finding is most significant when assessing the left extremity before the arteriogram? 1 Mottling of the leg 2 Coolness of the foot 3 Absence of the pedal pulse 4 Thickening of the toenails on the foot

Absence of the pedal pulse Absence of the left pedal pulse indicates inadequate circulatory status of the left lower extremity. Mottling of the left leg may indicate impaired circulation, but observation of both extremities for comparison is necessary. Coolness of the left foot is a less significant indication of arterial occlusive disease than the absence of a pulse. Thickening of the toenails on the left foot is not as significant as the pulse; this can occur because of inadequate circulation, aging, or fungal infection.

A client with varicose veins is scheduled for surgery. Which clinical finding does the nurse expect to identify when assessing the lower extremities of this client? 1 Pallor 2 Ankle edema 3 Yellowed toenails 4 Diminished pedal pulse

2. Ankle edema Ankle edema results from increased venous pressure. Pigmentation, not pallor, may occur with varicosities. Yellowed toenails occur with arterial, not venous, insufficiency. Diminished pedal pulses occur with arterial, not venous, insufficiency.

A client with varicose veins asks a nurse what is involved when ligation and stripping are performed rather than sclerotherapy. What should the nurse consider when planning a response in language the client will understand? 1 Plaque from within the veins is scraped. 2 The dilated saphenous veins are removed. 3 Superficial veins are sown together into deep veins. 4 An umbrella filter is placed in the large affected veins.

2. The dilated saphenous veins are removed. During a ligation, the saphenous vein is removed. Plaque is an arterial, rather than a venous, problem. Anastomosing (sewing together) superficial veins to deep veins is not done during this surgery; superficial and deep veins usually are attached by communicating veins. An umbrella filter placed in the large affected veins prevents emboli from traveling to the lung; it is not a vein ligation and stripping.

A nurse provides smoking cessation education to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that the client is ready to quit smoking when the client states: 1"I'll just finish the carton that I have at home. "2"I'll cut back to a half pack a day. "3"I find that smoking is the only way I can relax. "4"I should find this easy because I don't smoke when I drink.

2. The response "I'll cut back to a half pack a day" is a positive step in reducing smoking; it is the first step toward stopping. The response "I'll just finish the carton that I have at home" is postponing the decision to quit. The response "I find that smoking is the only way I can relax" is rationalizing why quitting smoking is too difficult. The response "I should find this easy" is unrealistic because giving up smoking is difficult regardless of if the client smokes when alcoholic beverages are consumed.

A nurse is discussing dietary guidelines to help reduce a client's risk for heart disease. What should the nurse teach the client? 1 Eat small, frequent meals. 2 Decrease the amount of proteins. 3 Increase complex carbohydrates. 4 Limit the amount of unsaturated fat.

3. Increase complex carbohydrates. The fiber component of complex carbohydrates helps bind and eliminate dietary cholesterol and fosters growth of intestinal microorganisms to break down bile salts and release the cholesterol component for excretion. It is what the client eats, not the amount at each meal that is important. Proteins need not be decreased; it is the type of protein that should be limited, such as fatty meat and the skin of fowl. Of the fats in the diet, saturated fats should be decreased.

The nurse is planning nutritional education for a client with lower extremity arterial disease (LEAD), also called peripheral arterial disease. Which diet modifications should the nurse include in the teaching session? 1 Decreasing both fluid and sodium intake 2 Increasing both calcium and potassium intake 3 Increasing both vitamin E and refined grain intake 4 Decreasing both cholesterol and saturated fat intake

4 Decreasing both cholesterol and saturated fat intake Lower extremity arterial disease frequently is accompanied by generalized atherosclerosis; decreasing both cholesterol and saturated fat intake will help decrease lipid buildup on artery walls. Decreasing both fluid and sodium intake is an inappropriate dietary modification; this client does not have edema. Increasing both calcium and potassium is not appropriate for the client's condition because it may alter the client's electrolyte balance. Supplemental vitamin E can precipitate cardiac/vascular problems and should be taken only when prescribed by a healthcare provider who can monitor the client's ongoing status. Increasing refined grain intake will add calories and may contribute to unnecessary weight gain.Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.

A client whose total cholesterol level is found to be 210 mg/dL (5.5 mmol/L) at a screening session at a health fair asks the nurse what to do in light of this result. How should the nurse respond? 1 "Your cholesterol is high, and you may need medication." 2 "This is within the acceptable range, and no action is required." 3 "Your level is low; you should eat more foods that contain cholesterol." 4 "Your cholesterol is elevated slightly. A diet low in saturated fats should be followed.

4. "Your cholesterol is elevated slightly. A diet low in saturated fats should be followed." A level more than 200 mg/dL (5 mmol/L) is considered elevated, and foods high in cholesterol and saturated fats should be limited in the diet. A level of 240 mg/dL (6.2 mmol/L) or more is considered high. Levels between 140 and 200 mg/dL (2 mmol/L to 5 mmol/L) are considered desirable. A low level is less than 140 mg/dL (2.0 mmol/L). Medical attention should be sought, because low cholesterol levels are associated with hyperthyroidism, malabsorption syndrome, malnutrition, and myeloproliferative disease.

A client with heart disease asks about cholesterol intake. When teaching the client, the nurse will explain what about cholesterol? 1 Found in both plant and animal sources 2 Causes an increase in serum high-density lipoprotein (HDL) 3 Should be eliminated because it causes the disease process 4 Contributes to high levels of low-density lipoprotein (LDL)

4. Contributes to high levels of low-density lipoprotein (LDL) Cholesterol is a sterol found in tissue; it is attributed in part to diets high in saturated fats and can be decreased with unsaturated fats. Only animal foods furnish dietary cholesterol. Exercise, not cholesterol, increases HDL levels and helps decrease the risk of heart disease. Cholesterol is also produced by the body and is needed for the synthesis of bile salts and adrenocortical and steroid sex hormones and it should not be eliminated. Cholesterol contributes to heart disease but is not the cause.

A client is at high risk for heart disease. Which instructions should the nurse include in the client's teaching plan? 1 Avoid eating between meals. 2 Limit unsaturated fats in the diet. 3 Decrease the amount of fat-binding fiber. 4 Increase the quantity of complex carbohydrates.

4. Increase the quantity of complex carbohydrates. The fiber component of complex carbohydrates helps bind and eliminate dietary cholesterol and fosters growth of intestinal microorganisms to break down bile salts and release the cholesterol component for excretion. It is what, not when, the client eats that is important. Saturated fats should be decreased. Fat-binding fiber should be increased.

When performing a physical assessment, the nurse identifies bilateral varicose veins. What does the nurse expect the client to report about the legs? 1 Burning sensations in the legs 2 Calf pain when the feet are dorsiflexed 3 Increased sensitivity of the legs to cold 4 Worsening ankle edema as the day progresses

4. Worsening ankle edema as the day progresses When the legs are dependent, gravity and incompetent valves promote increased hydrostatic pressure in leg veins; as a result, fluid moves into the interstitial spaces. Clients report feeling an ache or heaviness in the legs, not burning sensations. Calf pain when the feet are dorsiflexed, which is referred to as Homans sign, most often is associated with thrombophlebitis. Increasing sensitivity of the legs to cold reflects inadequate arterial blood supply; arterial circulation is not affected by varicose veins.

A client arrives at the outpatient clinic with a painful leg ulcer, and the nurse performs a physical assessment. Which clinical findings in the lower extremity support a diagnosis of an arterial ulcer? Select all that apply. 1 Lack of hair 2 Thickened toenails 3 Pain at the ulcer site 4 Diminished pedal pulse 5 Brown skin discoloration

1. Lack of hair 2. Thickened toenails 3. Pain at the ulcer site 4. Diminished pedal pulse Prolonged lack of oxygen to hair follicles results in hair loss. Prolonged lack of oxygen to the toes results in thickened toenails. Arterial ulcers are painful because of the interruption of blood supply to peripheral tissues. Inadequate arterial perfusion results in diminished volume of blood flow to the lower extremities. Brown skin discoloration is characteristic of venous ulcers.

A client has carotid atherosclerotic plaques, and a right carotid endarterectomy is performed. Two hours after surgery the client demonstrates progressive hypotension. Which action should the nurse take? 1 Notify the healthcare provider 2 Increase the intravenous (IV) flow rate 3 Raise the head of the bed 4 Place the client in the Trendelenburg position

1. Notify the healthcare provider The healthcare provider must evaluate the cause of the hypotension. Increasing the IV flow rate is a dependent function that requires a healthcare provider's prescription. Raising the head of the bed will further decrease blood flow to the brain. The Trendelenburg position is contraindicated because it will increase pressure in the carotid arteries.

A nurse is caring for a client with varicose veins. Which clinical manifestations should the nurse expect with this diagnosis? Select all that apply. 1 Presence of ankle edema 2 Increased muscle fatigue 3 Diminished peripheral pulses 4 Report of leg fullness and pruritus 5 Leg pain with activity that diminishes with rest

1. Presence of ankle edema 2. Increased muscle fatigue 4. Report of leg fullness and pruritus Presence of ankle edema, increased muscle fatigue, and a report of leg fullness and pruritus are signs of varicose veins caused by venous dilation resulting from incompetent valves that are expected to prevent backflow. Varicose veins do not affect arterial circulation (diminished pulses). Intermittent claudication occurs with decreased arterial, not venous, perfusion.

Which clinical indicator should the nurse expect to identify when assessing a client with varicose veins? 1 Positive Homans sign 2 Pallor of the affected extremity 3 Continuous edema of the lower legs 4 Sensation of heaviness in calf muscles

4. Sensation of heaviness in calf muscles Because of dilation in the veins and a concomitant decrease in blood flow, the client may experience heaviness or muscle cramps in the legs. Edema, if present, can be relieved by elevating the legs. Homans sign is calf pain when the ankle is dorsiflexed; usually it is related to thrombophlebitis. Pallor indicates decreased tissue perfusion that may be caused by a partial arterial occlusion. Edema usually decreases when the extremity is elevated.

A client reports foot pain and is diagnosed with arterial insufficiency. The nurse provides teaching about what the client can do to increase arterial dilation and to decrease foot pain. Which client statement indicates to the nurse that further teaching is needed? 1 "I will wear socks." 2 "I will elevate my foot." 3 "I will increase fluid intake." 4 "I will drink a moderate amount of alcohol."

2. "I will elevate my foot." Elevating the leg decreases the flow of blood to the lower extremity because it must flow without the assistance of gravity. Wearing socks should be encouraged because it keeps the feet warm, increasing arterial dilation and perfusion. Increasing fluid intake decreases the viscosity of blood, possibly preventing thrombus formation, and should be encouraged. Alcohol in moderation is useful as a drug to stimulate the dilation of blood vessels.

A nurse teaches a client with varicose veins about prevention of a thromboembolus. Which statement regarding preventive measures indicates the client requires further teaching? 1 "I must increase my fluid intake." 2 "I will massage my legs twice a day." 3 "Elastic stockings should be worn every day." 4 "Involving my upper and lower extremities in all exercises is important."

2. "I will massage my legs twice a day." Massaging the legs twice a day is unsafe if a thrombus is present because it may dislodge and cause an embolus. Fluids decrease blood viscosity, reducing the risk for thrombus formation. Elastic stockings physically compress veins, preventing venous stasis and lowering the risk for thrombus formation. Range-of-motion exercises prevent venous stasis and promote muscle tone; they propel venous blood toward the heart, facilitated by venous one-way valves.

When caring for a client with venous insufficiency, the nurse would implement which nursing measure? 1 Apply abdominal girdle as needed. 2 Remove compression stockings for client ambulation. 3 Elevate the client's legs above heart level. 4 Keep the upper extremities elevated.

3. Elevate the client's legs above heart level. Venous insufficiency occurs when vascular damage impedes the body's ability to move blood from the legs toward the heart. This causes blood to pool in the legs, where it can cause swelling; pain; and, in some cases, leaking fluid in the skin or ulcers. Elevation of the legs above the level of the heart makes use of gravitational forces to drain blood through the veins toward the heart. Clients should not wear tight restrictive pants and should avoid wearing a girdle or garter, which may impede venous return. Compression stockings prevent blood pooling. Elevating the upper extremities will not decrease edema in lower extremities.

A client with a long history of bilateral varicose veins questions a nurse about the brownish discoloration of the skin on the lower extremities. What should the nurse include in the response to the client's question? 1 The arterial blood supply is inadequate. 2 There is delayed healing in the area after an injury. 3 The production of melanin in the area has increased. 4 There is leakage of red blood cells (RBCs) through the vascular wall.

4. There is leakage of red blood cells (RBCs) through the vascular wall. Increased venous pressure alters the permeability of the veins, allowing extravasation of RBCs; lysis of RBCs causes brownish discoloration of the skin. Varicose veins do not affect the arterial circulation. Although healing may be delayed, the brownish discoloration does not result from trauma. There is no increase in melanocyte activity in individuals with varicose veins.

A nurse is providing dietary instruction to a client with cardiovascular disease. Which dietary selection by the client indicates that the nurse needs to reeducate the client? 1 Whole milk with oatmeal 2 Garden salad with olive oil 3 Tuna fish with a small apple 4 Soluble fiber cereal with yogurt

1 Whole milk with oatmeal An overall heart healthy diet includes a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts, legumes and non-tropical vegetable oils. Whole milk is high in saturated fat and should be avoided.Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is inexperienced would answer this question from only the information provided in the textbooks or given in the lectures.

A client comes to the outpatient clinic with a large leg ulcer. Which clinical finding will help the nurse determine that the ulcer is arterial? 1 Pain at the ulcer site 2 Bleeding around the ulcer area 3 Dependent edema of the extremities 4 Stasis dermatitis on the affected extremity

1. Pain at the ulcer site Arterial ulcers are painful because of their depth and interruption of blood supply. Bleeding around the ulcer area, dependent edema of the extremities, and stasis dermatitis on the affected extremity are characteristic of venous ulcers

)A nurse is teaching a group of clients about risk factors for heart disease. Which factors will the nurse include that increase a client's risk for a myocardial infarction (MI)? Select all that apply. 1 Obesity 2 Hypertension 3 Diabetes insipidus 4 Asian-American ancestry 5 Increased high-density lipoprotein (HDL

1. Obesity 2. Hypertension Obesity increases cardiac workload associated with vascular changes that lead to ischemia, which causes an MI. Hypertension damages blood vessels and increases peripheral resistance and cardiac workload, which may lead to an MI. Diabetes mellitus, not insipidus, is a risk factor for an MI. The risk is higher for African-Americans, not Asian-Americans. Increased levels of low-density lipoprotein (LDL), not HDL, increase the risk for heart disease.

A client with peripheral arterial insufficiency is scheduled for surgery. On admission, the client complains of discomfort and aches in the legs and feet. How should the nurse position the client's feet and legs? 1 Place them dependent to the torso. 2 Position them dependent by using a fully extended knee gatch. 3 Raise them to a two-pillow height above the buttocks. 4 Elevate them by raising the foot of the bed on blocks.

1. Place them dependent to the torso. Elevate them by raising the foot of the bed on blocks. Gravity will assist the flow of blood to the dependent legs and feet. An extended knee gatch keeps extremities horizontal, not dependent, and does not facilitate blood flow to the feet. Elevation impedes flow of arterial blood to the extremities; it facilitates venous return.

A client who has always been active is diagnosed with atherosclerosis and hypertension. The client is interested in measures that will help promote and maintain health. Which recommendation by the nurse will help the client maintain blood vessel patency? 1 Practice relaxation techniques. 2 Lead a more sedentary lifestyle. 3 Limit cardiovascular exercise. 4 Increase saturated fats in the diet.

1. Practice relaxation techniques. Research has shown that decreasing stress will slow the rate of atherosclerotic development. Exercise is thought to decrease atherosclerosis and the formation of lipid plaques. Saturated fats in the diet are contraindicated because they increase the risk for atherosclerosis.

A client is admitted to the hospital with a diagnosis of lower extremity arterial disease (LEAD) or peripheral arterial disease. Which is the most beneficial lifestyle modification the nurse should teach this client? 1 Stop smoking 2 Control blood glucose 3 Start a walking program 4 Eat a low-fat, low-cholesterol diet

1. Stop smoking Smoking is the single most important risk factor for peripheral arterial diseases, and cessation should be encouraged. Although hyperglycemia is a contributing factor, it is not the primary risk factor for LEAD. Although a sedentary lifestyle is a contributing factor, it is not the primary risk factor for LEAD. Although a high-fat, high-cholesterol diet is a contributing factor, it is not the primary risk factor for LEAD.

A client is admitted to the hospital with a large leg ulcer, and a femoral angiogram is performed. What should the nurse do after this procedure? 1 Provide passive range of motion (ROM) to all extremities 2 Elevate the foot of the bed for 36 hours 3 Assist the client to stand if unable to void 4 Apply pressure to the catheter insertion site

4. Apply pressure to the catheter insertion site Pressure promotes coagulation and prevents the complication of bleeding. Bending the operative leg may cause decreased perfusion to the leg or bleeding at the catheter insertion site. Elevation will resist gravity flow of arterial blood, reducing oxygen to distal tissue. The client should remain in the supine position for 4 to 6 hours to prevent bleeding at the insertion site.

A client who is considering sclerotherapy asks the nurse to explain what causes varicose veins. Which response by the nurse is best? 1 "The cause is abnormal configurations of the veins." 2 "The cause is incompetent valves of superficial veins." 3 "The cause is decreased pressure within the deep veins." 4 "The cause is atherosclerotic plaque formation in the veins."

2. "The cause is incompetent valves of superficial veins." Incompetent valves result in retrograde venous flow and subsequent dilation of veins. Abnormal configurations of the veins are considered a result of, rather than a cause of, varicose veins. Pressure within the deep veins is increased, not decreased. Plaque formation is considered an arterial, rather than a venous, problem and is associated with atherosclerosis.

When supporting vasodilation by the use of warmth for a client with peripheral arterial insufficiency, what should the nurse caution the client to avoid? 1 Applying a hot water bottle to the abdomen 2 Using a heating pad to warm the extremities 3 Drinking a warm cup of tea when feeling chilly 4 Turning the room thermostat above 72° F (23.3° C)

2. Using a heating pad to warm the extremities The client's extremities are less sensitive to thermal stress because of peripheral vascular problems, and burns may occur. Applying heat to the abdomen causes reflex dilation of the arteries in the extremities and increases blood flow without untoward effects. Raising the internal temperature by drinking warm fluid prevents vascular constriction and warms the extremities. Increasing heat of the external environment is an effort to prevent cold, chilling, and further constriction of peripheral vasculature.

A client with a 40-year history of drinking two alcoholic beverages and smoking two packs of cigarettes daily comes to the outpatient clinic with an ischemic left foot. It is determined that the cause is arterial insufficiency. The nurse concludes that the pain in the client's foot is a result of inadequate blood supply. Which information from the client will cause the nurse to intervene? 1 I have one glass of wine at supper. 2 I lower my limb when sitting. 3 I am a social smoker. 4 I drink a lot of water.

3. I am a social smoker. Nicotine (I am a social smoker) causes vasoconstriction and spasm of the peripheral arteries; therefore the nurse will intervene. Alcohol may stimulate dilation of blood vessels; one glass is not harmful. Lowering the limb enhances flow of blood into the foot by gravity to assist with the inadequate blood supply. Consuming water will decrease the viscosity of blood, possibly preventing the formation of thrombi.Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or responses that appear to be degrading.

A client with arterial insufficiency of both lower extremities is visited by the home healthcare nurse. What client teaching is an essential nursing intervention? 1 "Maintain elevation of both legs." 2 "Massage the legs when they are painful." 3 "Apply a hot water bottle to the legs." 4 "Check pulses in the legs regularly."

4. "Check pulses in the legs regularly." Altered quantity and quality of pulses are the earliest indications of increasingly limited circulation. Maintaining elevation of both legs prevents the use of gravity to carry arterial blood to the legs and feet. Massaging the legs when painful can release an embolus into the circulation and cause tissue trauma. Altered sensation may limit sensitivity to heat, which can result in burns.

A client is diagnosed with varicose veins, and the nurse teaches the client about the pathophysiology associated with this disorder. The client asks, "What can I do to help myself?" How should the nurse respond? 1 "Limit walking to as little as possible." 2 "Reduce fluid intake to 1 L of liquid a day." 3 "Apply moisturizing lotion on your legs several times a day." 4 "Put on compression hose before getting out of bed in the morning."

4. "Put on compression hose before getting out of bed in the morning." As valves become incompetent, they allow blood to pool in the veins, which increases hydrostatic pressure and leads to further valve destruction. Compression hose provide external pressure, thereby facilitating venous return and minimizing blood pooling in the veins. The legs are less congested after sleeping, and therefore the hose should be put on before getting out of bed in the morning and before the legs are in the dependent position. The client should engage in exercise such as walking or swimming because muscle contraction encourages venous return to the heart. Prolonged sitting, standing, or crossing the legs should be avoided because they reduce venous return. Limiting fluid intake will not alter the leakage of fluid or blood into the interstitial space; this occurs in response to the increased hydrostatic pressure in the veins. Although applying moisturizing lotion may make the skin more supple, it will not treat enlarged and tortuous veins.

What is the most important teaching for a nurse to provide for a client who had sclerotherapy for varicose veins? 1 Limit activity until edema subsides. 2 Remove compression bandages when in bed. 3 Place a pillow under the knees when lying in bed. 4 Walk for several minutes every hour when awake.

Walk for several minutes every hour when awake. Walking activities are encouraged to improve circulation and dilute the sclerosing agent. Limiting activity is contraindicated; inactivity contributes to venous stasis and engorgement of veins. Compression bandages should be left in place for several days to ensure external compression of veins, which enhances venous return. Placing a pillow under the knees when lying in bed is contraindicated because it will impede venous return.STUDY TIP: The old standbys of enough sleep and adequate nutritional intake also help keep excessive stress at bay. Although nursing students learn about the body's energy needs in anatomy and physiology classes, somehow they tend to forget that glucose is necessary for brain cells to work. Skipping breakfast or lunch or surviving on junk food puts the brain at a disadvantage.

A client presents with bilateral leg pain and cramping in the lower extremities. The client has a history of cardiovascular disease, diabetes, and varicose veins. To guide the assessment of the pain and cramping, the nurse should include which question when completing the initial assessment? 1 "Does walking for long periods of time increase your pain?" 2 "Does standing without moving decrease your pain?" 3 "Have you had your potassium level checked recently?" 4 "Have you had any broken bones in your lower extremities?"

1. "Does walking for long periods of time increase your pain?" Clients with a medical history of heart disease, hypertension, phlebitis, diabetes, or varicose veins often develop vascular-related complications. The nurse should recognize that the relationship of symptoms to exercise will clarify whether the presenting problem is vascular or musculoskeletal. Pain caused by a vascular condition tends to increase with activity. Musculoskeletal pain is not usually relieved when exercise ends. Low potassium levels can cause cramping in the lower extremities; however, given the client's health history, vascular insufficiency should be suspected. Previously healed broken bones do not cause cramping and pain.1.

A primary healthcare provider prescribes a heart-healthy diet for a client with angina. The client's spouse says to the nurse, "I guess I'm going to have to cook two meals, one for my spouse and one for myself." Which is the most appropriate response by the nurse? 1 "The diet prescribed for your spouse is a healthy diet. It contains guidelines that many of us should follow." 2 "I wouldn't bother. For this diet all that you need to do is to reduce the amount of salt you use and fry foods in peanut oil." 3 "You're right. Be careful to cook a small portion for each of you to eat to not waste food." 4 "This is a difficult diet to follow. I recommend that you shop daily for food so there are no temptations in the kitchen."

1. "The diet prescribed for your spouse is a healthy diet. It contains guidelines that many of us should follow." Heart-healthy diets are low in cholesterol, sodium, and fat, particularly saturated fats, and high in vegetables and fruits; this type of diet is advocated for all individuals. Fried foods are not advocated on a heart-healthy diet; peanut oil is a monounsaturated fatty acid, and these acids should not exceed 15% of the calories of the diet. The responses "You're right. Be careful to cook a small portion for each of you to eat to not waste food" and "This is a difficult diet to follow. I recommend that you shop daily for food so there are no temptations in the kitchen" can be discouraging and encourage noncompliance.

A nurse is completing the admission assessment of a client with peripheral arterial disease. Which assessments will the nurse expect to observe? Select all that apply. 1 Absence of hair on the toes 2 Superficial ulcer with irregular edges 3 Pitting edema of the lower extremities 4 Reports of pain associated with exercising 5 Increased pigmentation of the medial malleolus area

1. Absence of hair on the toes 4. Reports of pain associated with exercising The absence of hair on the toes occurs because of diminished circulation. Reports of pain associated with exercising (intermittent claudication) are common because the increased need for oxygen leads to ischemia when arterial flow is impaired. A superficial ulcer with irregular edges is associated with venous insufficiency; the ulcer associated with arterial insufficiency is deep and well demarcated. Pitting edema of the lower extremities is associated with venous insufficiency. Increased pigmentation of the medial and lateral malleolus areas is associated with venous insufficiency.

The nurse is assessing a client's pulse strength and records it as a 3+. Which description best describes this client's pulse strength? 1 Bounding 2 Absent 3 Expected 4 Diminished

1. Bounding A pulse strength of 3+ is considered full or bounding. A pulse strength is considered normal, expected, and easily palpable when it is 2+. The pulse strength is diminished or barely palpable when the score is 1+. An absent pulse is a grade 0 pulse.

A nurse attempts to give a client with chronic arterial insufficiency of the legs the prescribed dose of aspirin (ASA). The client refuses it, stating, "My legs are not painful." Which action by the nurse is appropriate? 1 Explain the reason for the medication and encourage the client to take it 2 Withhold the medication at this time and return to check with the client again in 30 minutes 3 Withhold the medication and tell the client to ask for it if the legs become uncomfortable 4 Request that the client take the medication and explain that it prevents the client from being uncomfortable in the next few hours

1. Explain the reason for the medication and encourage the client to take it Aspirin is given to the client to prevent platelet aggregation and possible deep vein thrombosis. The client needs information to make an educated decision. Aspirin is not prescribed to relieve pain. The client should receive information and support before making the decision to refuse the medication. Clients should never be pressured to take medication, especially when they do not have an understanding of the risks and benefits of the medication.

A nurse is collecting data from a client with varicose veins who is to have sclerotherapy. What should the nurse expect the client to report? 1 Feeling of heaviness in both legs 2 Intermittent claudication of the legs 3 Calf pain on dorsiflexion of the foot 4 Hematomas of the lower extremities

1. Feeling of heaviness in both legs Impaired venous return causes increased pressure, with symptoms of fatigue and heaviness. Pain when walking relieved by rest (intermittent claudication) is a symptom related to hypoxia. Symptoms of hypoxia are related to impaired arterial, rather than venous, circulation. Calf pain on dorsiflexion of the foot is Homans sign, which is suggestive of thrombophlebitis. Ecchymoses may occur in some individuals, but bleeding into tissue is insufficient to cause hematomas.

Which condition may cause the gradual occlusion of the internal or common carotid arteries, manifested by transient ischemic attacks? 1 Acquired valvular heart disease 2 Atherosclerosis of the vascular system 3 Emboli associated with atrial fibrillation 4 Developmental defects of the arterial wall

2. Atherosclerosis of the vascular system Gradual occlusion of the carotid arteries, manifested by the transient ischemia attacks, is caused almost exclusively by atherosclerotic thrombosis. Valvular heart disease, whether acquired or congenital, usually causes cerebral emboli, not gradual occlusion of the carotid arteries. Emboli resulting from atrial fibrillation causes sudden and complete, not partial, occlusion of the vessels. Developmental defects of the arterial wall are associated with saccular aneurysms.

A client who had injection sclerotherapy for varicose veins is advised to wear compression (support) stockings. What is most important for the nurse to explain to the client about compression stockings? 1 Put the stockings on at the first sign of discomfort. 2 Don the stockings before getting out of bed in the morning. 3 Ensure that the cuff of the stockings reaches the middle of the knees. 4 Substitute elastic bandages for compression stockings if they are more comfortable.

2. Don the stockings before getting out of bed in the morning. To prevent distention of the veins, stockings should be applied before the legs are placed in a dependent position. Stockings should be used preventively before the discomfort associated with venous pressure and edema occurs. Knee-high stockings should end 2 inches (5.1 cm) below the knee to avoid popliteal pressure, which limits venous return. Stockings apply uniform pressure. Elastic bandages may slip or develop wrinkles, creating uneven pressure and constriction; edema may result.

A 42-year-old adult with a long history of alcohol abuse seeks help in one of the local hospitals. What does the nurse consider to be the major underlying factor for success in a client's alcohol treatment program? 1. Family 2. Motivation 3. Practitioner 4. Self-esteem

2. Motivation Motivation is necessary to help the client withstand the pain of giving up a defense; internal motivation is more influential in facilitating change than any external factor. Although having family support is important, internal motivation to change is the most important factor. The client's practitioner can be of assistance, but internal factors will have a greater effect on rehabilitation than external factors. Self-esteem will be useful if it precipitates abstinence behavior; however, people who are alcoholics commonly have low self-esteem.

A nurse is caring for a client with a diagnosis of varicose veins. Which clinical findings can the nurse expect to identify when assessing this client? Select all that apply. 1 Discolored toenails 2 Reports of leg fatigue 3 Localized heat in a calf 4 Reddened areas on a leg 5 Tortuous veins in the legs 6 Pain in lower extremities when standing

2. Reports of leg fatigue 5. Tortuous veins in the legs 6. Pain in lower extremities when standing Leg fatigue is a common clinical manifestation caused by venous stasis and inadequate tissue oxygenation. Vein walls weaken and dilate resulting in distended, protruding veins that appear tortuous and darkened. As vein walls weaken and dilate, venous pressure increases and the valves become incompetent; venous stasis and inadequate oxygenation result in leg pain. Discolored toenails result from a fungus under the nail or chronic hypoxia, not varicose veins. Localized heat in a calf and reddened areas on a leg are signs of thrombophlebitis.

The healthcare provider prescribes a progressive exercise program that includes walking for a client with a history of diminished arterial perfusion to the lower extremities. The nurse explains to the client what to do if leg cramps occur while walking. Which instruction did the nurse give the client? 1 Chew one aspirin twice a day. 2 Stop to rest until the pain resolves. 3 Walk more slowly while pain is present. 4 Take one nitroglycerin tablet sublingually.

2. Stop to rest until the pain resolves. During an exercise program, the client walks to the point of claudication, stops and rests, and then walks a little farther. Decreasing the demand for oxygen by resting will relieve the pain. Pain will not resolve as long as exercise, thus muscle hypoxia, is continued, regardless of whether aspirin is taken. Walking more slowly while pain is present is appropriate for venous insufficiency, not arterial insufficiency. Sublingual nitroglycerin is not indicated for leg cramps.

Knee-length elastic support stockings are prescribed for a client with varicose veins. What should the nurse teach the client about the elastic stockings? 1 The stockings should reach the middle of the knee. 2 The stockings should be applied before getting out of bed. 3 The stockings should be applied at the first sign of discomfort. 4 The stockings may be substituted with loose elastic bandages.

2. The stockings should be applied before getting out of bed. To prevent distention of the veins, the stockings should be applied before the legs are placed in a dependent position. Knee-high stockings should end 2 inches (5 cm) below the knee to avoid popliteal pressure, which limits venous return. The stockings should be used preventatively before the discomfort associated with venous pressure and edema occurs. The stockings apply uniform pressure; loose elastic bandages may slip, creating uneven, ineffective pressure. Edema also may result.

A client with a history of occasional pain in the left foot when walking now has pain at rest. The left foot is cyanotic, numb, and painful. The suspected cause is arteriosclerosis. Which information will the nurse share with the client to help decrease the pain? 1 Keep the left foot cool 2 Cross legs with the left one on top 3 Comply with the prescribed exercise program 4 Keep the foot elevated at a 30-degree angle

3 Comply with the prescribed exercise program An exercise/rest program helps develop collateral circulation, which improves well-being and enables clients to increase their ability to walk longer distances. A cool environment favors constriction of peripheral blood vessels and further decreases arterial flow. Crossing the legs increases local pressure, which tends to occlude blood vessels. Elevation slows inflow of arterial blood, leading to further oxygen deprivation and pain.

A nurse is planning to provide self-care health information to several clients. Which client should the nurse anticipate will be most motivated to learn? 1 A 55-year-old client who had a mastectomy and is very anxious about her body image 2 An 18-year-old client who smokes cigarettes and is in denial about the dangers of smoking 3 A 56-year-old client who had a heart attack last week and is requesting information about exercise 4 A 47-year-old client who has a long-leg cast after sustaining a broken leg and is still experiencing severe pain

3 A 56-year-old client who had a heart attack last week and is requesting information about exercise A client who is requesting information is indicating a readiness to learn. When a nurse is caring for a person who is coping with the diagnosis of cancer and a change in body image, the nurse should encourage the expression of feelings, not engage in teaching. People in denial are not ready to learn because they do not admit they have a problem. In addition, many adolescents believe that they are invincible. A person who is in pain is attempting to cope with a physiological need. This client is not a candidate for teaching until the pain can be lessened; pain can preoccupy the client and prevent focusing on the information being presented.

A client with intermittent claudication has been instructed to stop smoking and doesn't understand why this is necessary. Which is the nurse's best response? 1 "The policy states that the hospital is a smoke-free environment." 2 "Nicotine thins the blood and should be avoided in clients that take anticoagulants." 3 "Nicotine is a vasoconstrictor and should be avoided in clients with arterial problems." 4 "The healthcare provider may allow you to begin smoking again after you are feeling better."

3. "Nicotine is a vasoconstrictor and should be avoided in clients with arterial problems." The response "Nicotine is a vasoconstrictor and should be avoided in clients with arterial problems" is a truthful answer that explains how nicotine is detrimental to physical status. Nicotine also can increase blood viscosity. Although the hospital is a smoke-free environment, it is not an appropriate explanation of why the client should not smoke. The healthcare provider probably will advise against smoking because resuming smoking will continue to decrease oxygen flow to the lower extremities.

An older client tells the nurse, "My legs begin to hurt after walking the dog for several blocks. The pain goes away when I stop walking, but it comes back again when I resume walking." Which condition does the nurse consider as the most likely cause of the client's pain? 1 Spinal stenosis 2 Buerger disease 3 Rheumatoid arthritis 4 Intermittent claudication

4. Intermittent claudication Pain that develops during exercise is a classic symptom of peripheral arterial occlusive disease; arterial occlusion prevents adequate blood flow to the muscles of the legs, causing ischemia and pain. Spinal stenosis is associated with chronic back pain. Buerger disease is associated with foot pain and cramping; rubor may be present, and pedal pulses may be absent. Rheumatoid arthritis is associated with joint pain, erythema, and swelling; pain may be present with or without activity, particularly when one is awakening.

A client who had a femoropopliteal bypass graft is receiving clopidogrel postoperatively. What should the nurse teach the client related to the medication? 1 Eliminate starches and red meats from the diet 2 Eat more roughage if constipation occurs 3 Report any occurrence of multiple bruises 4 Take the medication on an empty stomach

3. Report any occurrence of multiple bruises Clopidogrel is a platelet aggregation inhibitor that decreases the probability of clots forming where the graft was placed, but it also increases bleeding tendencies when the dosage is excessive. Clopidogrel does not interact with starches or red meats, which are permitted in the diet. Diarrhea, not constipation, is more likely to occur with clopidogrel. Clopidogrel should be taken with food to decrease the side effects of gastric discomfort, diarrhea, and gastrointestinal bleeding. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.

A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply. 1 Age 2 Height 3 Weight 4 Smoking 5 Family history

3. Weight 4. Smoking Obesity is a modifiable risk factor that is associated with coronary artery disease (CAD); an increased fat intake contributes to an increased serum cholesterol and atherosclerosis. Smoking, which constricts the blood vessels, is a modifiable risk factor for CAD. The incidence of CAD does increase with age. However, age is not a modifiable risk factor. Height is unrelated to the incidence of CAD. Family history is not a modifiable risk factor for CAD because one cannot control heredity.

A nurse identifies that an older adult has not achieved the desired outcome from a prescribed proprietary medication. When assessing the situation, the client shares that the medication is too expensive and the prescription was never filled. What is an appropriate nursing response? 1.Ask the pharmacist to provide a generic form of the medication. 2.Encourage the client to acquire the medication over the internet. 3.Inform the health care provider of the inability to afford the medication. 4.Suggest that the client purchase insurance that covers prescription medications

3.Inform the health care provider of the inability to afford the medication. The healthcare provider needs to be aware of the reason for the client's lack of response to the medication so that an alternate treatment plan or financial assistance can be arranged. A healthcare provider may prefer the proprietary form of the medication. To ask the pharmacist to provide a generic form of the medication is unsafe. To recommend that the client obtain a generic form of the medication is not within the legal role of the nurse, unless the healthcare provider documents that this is acceptable. Medications purchased over the Internet may be illegally imported, counterfeit, expired, or contaminated and therefore should be avoided. Although some prescription insurance plans may help to reduce the cost of some medications, the client may not be able to afford the insurance.

A client expresses concern that because of supply and demand there is no vaccine available for the annual flu vaccine. What is the nurse's best reply? 1 "It's unfortunate, but there was such a limited supply available." 2 "There are many others who also were unable to get a flu vaccine." 3 "It doesn't matter because the vaccine is for just one particular strain." 4 "There are other things you can do to prevent the flu, such as hand washing."

4. "There are other things you can do to prevent the flu, such as hand washing." The statement "There are other things you can do to prevent the flu, such as hand washing" is a teaching opportunity of which the nurse can take advantage and show the client the things that can be done to avoid infection. The response "It's unfortunate, but there was such a limited supply available" is empathic, but it does not address the client's concern of vulnerability. The response "There are many others who also were unable to get a flu vaccine" belittles the client for being concerned. The response "It doesn't matter because the vaccine is for just one particular strain" may be true, but it belittles the client's concern.

A client with impaired peripheral pulses and signs of chronic hypoxia in a lower extremity is scheduled for a femoral angiogram. What would be appropriate for the nurse to include in the postprocedure plan of care? 1 Elevate the foot of the bed. 2 Perform urinary catheter care every 12 hours. 3 Place in the high-Fowler position. 4 Perform a neurovascular assessment every 2 hours

4. Perform a neurovascular assessment every 2 hours. Because of the trauma associated with the insertion of the catheter during the procedure, the involved extremity should be assessed for sensation, motor ability, and arterial perfusion; hemorrhage or an arterial embolus can occur. The client has an arterial problem, and perfusion is promoted by keeping the legs at the level of or lower than the heart. A general anesthetic is not used; therefore voiding is not a concern. Keeping the client in the high-Fowler position is unsafe; this position increases pressure in the groin area, which can dislodge the clot at the catheter insertion site, resulting in bleeding. It also impedes arterial perfusion and venous return.

A client refuses to go to the twice-a-day prescribed sessions in physical therapy. How might the nurse best approach this problem? 1 Having the client observe the progress of a more cooperative client with the same problem 2 Being the client's advocate and asking the primary healthcare provider whether therapy can be decreased to once daily 3 Ensuring that pain medication is administered to the client before the scheduled physical therapy sessions 4 Planning a conference with the client, the physical therapist, and the nurse present to discuss the client's feelings

4. Planning a conference with the client, the physical therapist, and the nurse present to discuss the client's feelings Planning a conference with the client, the physical therapist, and the nurse present to discuss the client's feelings includes the client in the problem-solving process. Having the client observe the progress of a more cooperative client with the same problem, being the client's advocate and asking the primary healthcare provider whether therapy can be decreased to once daily, and ensuring that pain medication is administered to the client before the scheduled physical therapy sessions do not include the client in the problem-solving process; more data should be obtained from the client before deciding on an intervention, which may or may not be appropriate.

A nurse is developing a teaching plan for a client with lower extremity arterial disease (LEAD). Which information will the nurse include in the teaching plan? 1 Trimming toenails so that they are short and rounded 2 Checking bathwater temperature by putting the toes in first 3 Using alcohol to rub hands, feet, legs, and arms at least two times a day 4 Seeking professional treatment for any minor injuries to the extremities

4. Seeking professional treatment for any minor injuries to the extremities Because diminished circulation leads to inadequate healing, early treatment of injuries is essential. Toenails should not be too short and should be trimmed straight across. Bathwater should be checked with a bath thermometer; toes of persons with peripheral artery disease (PAD) may be less sensitive to temperature change, and a burn may occur. These clients develop trophic skin changes; the drying action of alcohol will contribute to dryness and skin breakdown.

A client with emphysema has a history of smoking two packs of cigarettes a day. What is the best approach for the nurse to help the client stop smoking? 1. Teach pursed-lip breathing 2. Encourage the client to reduce emotional stress 3. Obtain a referral to a smoking cessation program in the community 4. Suggest that the client limit smoking to one pack of cigarettes a day

4. Suggest that the client limit smoking to one pack of cigarettes a day. Limiting the number of cigarettes smoked daily may be an effective first step toward smoking cessation [1] [2]. An all-or-none approach often is not effective. The ultimate goal is to eliminate smoking entirely. Pursed-lip breathing improves exhalation of CO2, but it will not help the client stop smoking. Emotional stress may or may not be associated with the client's smoking; usually it is an addiction to nicotine that drives the need to smoke. The client needs to be motivated to stop smoking; a referral without a personalized discussion is not enough for an addicted smoker to pursue a smoking-cessation program.

While assessing a client for the dorsalis pedis pulse, a nurse documents the reading as 1+. What can be inferred from this finding? 1 There is absence of a pulse. 2 The pulse strength is normal. 3 The pulse strength is bounding. 4 The pulse strength is barely palpable

4. The pulse strength is barely palpable. A pulse strength of 1+ indicates a diminished or barely palpable pulse and requires immediate intervention. Absence of pulse is documented as 0. Normal pulse strength is documented as 2+. If the pulse strength is bounding, then it is documented as 4+.

A nurse is caring for a client with chronic occlusive arterial disease. Which precipitating cause is the nurse most likely to identify for the development of ulceration and gangrenous lesions? 1 Emotional stress, which is short-lived 2 Poor hygiene and adequate protein intake 3 Stimulants such as coffee, tea, or cola drinks 4 Trauma from mechanical, chemical, or thermal sources

4. Trauma from mechanical, chemical, or thermal sources Diminished sensation decreases awareness of injury. Injured tissue cannot heal properly because of cellular deprivation of oxygen and nutrients; ulceration and gangrene may result. Emotional stress does not cause tissue injury; however, because of vasoconstriction, it may prolong healing. Inadequate hygiene is only one stress that may cause tissue trauma; adequate protein is not related to this disease. Although caffeine stimulates the peripheral vessels to constrict, limiting oxygen to cells, it is not the major cause of ulceration.