Chapter 30 AH Test

Health teaching for a patient diagnosed with Raynaud's phenomenon would include advising the patient to avoid the most common factor known to trigger episodes. Which of the following is the most common factor? Jobs/hobbies that involve vibrations Allergens Strenuous exercise Cold and stress

Cold and stress

A nurse is reviewing self-care measures for a client with peripheral vascular disease. Which statement indicates proper self-care measures? "I stopped smoking and use only chewing tobacco." "I like to soak my feet in the hot tub every day." "I have my wife look at the soles of my feet each day." "I walk only to the mailbox in my bare feet."

"I have my wife look at the soles of my feet each day."

The nurse is monitoring a patient who is on heparin anticoagulant therapy. What should the nurse determine the therapeutic range of the international normalized ratio (INR) should be? 4.0-5.0 5.0-6.0 7.0-8.0 2.0-3.0

2.0-3.0

A nurse is teaching a client who will soon be discharged with a prescription for warfarin (Coumadin). Which statement should the nurse include in discharge teaching? "Don't take aspirin while you're taking warfarin." "Eat more yogurt and broccoli." "If you miss a dose, double the next dose." "This drug will dissolve any clots you may still have."

"Don't take aspirin while you're taking warfarin."

A nurse in the rehabilitation unit is caring for an older adult client who is in cardiac rehabilitation following an MI. The nurse's plan of care calls for the client to walk for 10 minutes 3 times a day. The client questions the relationship between walking and heart function. How should the nurse best reply? "When you walk, the muscles in your legs contract and pump the blood in your veins back toward your heart, which allows more blood to return to your heart." "The arteries in your legs constrict when you walk and allow the blood to move faster and with more pressure on the tissue." "Walking increases your heart rate and blood pressure. Therefore, your heart is under less stress." "Walking helps your heart adjust to your new arteries and helps build your self-esteem."

"When you walk, the muscles in your legs contract and pump the blood in your veins back toward your heart, which allows more blood to return to your heart."

A client with venous insufficiency asks the nurse what they can do to decrease their risk of complications. What advice should the nurse provide to clients with venous insufficiency? Elevate the legs periodically for at least an hour. Refrain from sexual activity for a week. Avoid foods with iodine. Elevate the legs periodically for at least 15 to 20 minutes.

Elevate the legs periodically for at least 15 to 20 minutes.

Which statement is accurate regarding Reynaud disease? It is most common in men 16 to 40 years of age. Episodes may be triggered by unusual sensitivity to cold. The disease generally affects the client bilaterally. It affects more than two digits on each hand or foot.

Episodes may be triggered by unusual sensitivity to cold.

A nurse is developing a nursing care plan for a client with peripheral arterial disease. Which of the following will be the priority nursing diagnosis? Ineffective thermoregulation Ineffective self-health management Impaired tissue integrity Ineffective peripheral tissue perfusion

Ineffective peripheral tissue perfusion

A nurse is teaching a client newly diagnosed with arterial insufficiency. Which term should the nurse use to refer to leg pain that occurs when the client is walking? Orthopnea Dyspnea Thromboangiitis obliterans Intermittent claudication

Intermittent claudication

Which of the following is the hallmark symptom for peripheral arterial disease (PAD) in the lower extremity? Intermittent claudication Dizziness Vertigo Acute limb ischemia

Intermittent claudication

Which term refers to a muscular, cramplike pain in the extremities consistently reproduced with the same degree of exercise and relieved by rest? Intermittent claudication Aneurysm Ischemia Bruit

Intermittent claudication

A nurse is assessing a client's right lower leg, which is wrapped with an elastic bandage. Which signs and symptoms suggest circulatory impairment? Numbness, cool skin temperature, and pallor Numbness, warm skin temperature, and redness Redness, cool skin temperature, and swelling Swelling, warm skin temperature, and drainage

Numbness, cool skin temperature, and pallor

A client with systemic lupus erythematosus (SLE) complains that his hands become pale, blue, and painful when exposed to the cold. What disease should the nurse cite as an explanation for these signs and symptoms? Buerger's disease Raynaud's disease Peripheral vascular disease Arterial occlusive diseases

Raynaud's disease

When assessing a client with cellulitis of the right leg, which finding should the nurse expect to observe

Red, swollen skin with inflammation spreading to surrounding tissues.Explanation:Cellulitis, an inflammation of soft tissues, can extend to surrounding tissues. The skin becomes reddened, warm, swollen, and sometimes painful. The skin wouldn't be cold, pale, or necrotic.

Following abdominal surgery, which factor predisposes a client to deep vein thrombosis? The client will be immobile during and shortly after surgery. The client has been pregnant four times. The client usually walks 3 miles a day. The client is 5' 9" tall and weighs 128 lb (58 kg).

The client will be immobile during and shortly after surgery.

What symptoms should the nurse assess for in a client with lymphedema as a result of impaired nutrition to the tissue? Cyanosis Evident scarring Ulcers and infection in the edematous area Loose and wrinkled skin

Ulcers and infection in the edematous area

The nurse teaches the client with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes vasospasm. slows the heart rate. causes diuresis. depresses the cough reflex.

causes vasospasm.

The most important reason for a nurse to encourage a client with peripheral vascular disease to initiate a walking program is that this form of exercise: reduces stress. decreases venous congestion. increases high-density lipoprotein (HDL) level. aids in weight reduction.

decreases venous congestion.

The nurse teaches the client with peripheral vascular disease (PVD) to refrain from smoking because nicotine causes depression of the cough reflex. slowed heart rate. diuresis. vasospasm.

vasospasm.