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NurseDive Free Nursing Practice Question
A nurse is caring for a client who has peripheral arterial disease (PAD). Which of the following symptoms should the nurse expect to find in the early stage of the disease?
A. Dependent rubor
Dependent rubor is a sign of PAD in the advanced stage, due to the impaired vasodilation and reactive hyperemia. It is a reddish color of the lower extremities that occurs when they are lowered and disappears when they are elevated.
B. Intermitent claudication
Intermittent claudication is a characteristic symptom of PAD in the early stage, due to the reduced blood flow to the muscles during exercise. It is a cramping pain in the legs that occurs with walking and is relieved by rest.
C. Foot ulcers
Foot ulcers are a complication of PAD in the late stage, due to the poor wound healing and tissue necrosis. They are usually located on the toes, heels, or pressure points.
D. Rest pain
Rest pain is another sign of PAD in the late stage, due to the severe ischemia and nerve damage. It is a persistent pain in the feet or toes that occurs at night and is not relieved by rest.
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Full Explanation
The correct answer is B
Choice B reason: Intermittent claudication
Intermittent claudication is a characteristic symptom of PAD in the early stage, due to the reduced blood flow to the muscles during exercise. It is a cramping pain in the legs that occurs with walking and is relieved by rest.
Choice A reason: Dependent rubor is a sign of PAD in the advanced stage, due to the impaired vasodilation and reactive hyperemia. It is a reddish color of the lower extremities that occurs when they are lowered and disappears when they are elevated.
Choice C reason: Foot ulcers are a complication of PAD in the late stage, due to the poor wound healing and tissue necrosis. They are usually located on the toes, heels, or pressure points.
Choice D reason: Rest pain is another sign of PAD in the late stage, due to the severe ischemia and nerve damage. It is a persistent pain in the feet or toes that occurs at night and is not relieved by rest.
Similar Questions
A nurse is caring for a client who has a new diagnosis of essential hypertension. The nurse should monitor the client for which of the following findings that is consistent with this diagnosis?
A. Vertigo
Vertigo is not a typical finding of essential hypertension, but it may occur in clients who have orthostatic hypotension, vestibular disorders, or cerebrovascular accidents.
B. Blurred vision
Blurred vision is a possible finding in clients who have essential hypertension, due to the damage to the retinal vessels and optic nerve. It may indicate a hypertensive emergency or a target organ damage.
C. Dyspnea
Dyspnea is not a specific finding of essential hypertension, but it may indicate a pulmonary edema, heart failure, or anemia.
D. Uremia
Uremia is a complication of essential hypertension, due to the renal impairment and accumulation of waste products in the blood. It may cause nausea, vomiting, fatigue, pruritus, and confusion.
Full Explanation
A: Vertigo is a common finding in clients with essential hypertension due to changes in blood flow and possible impacts on the inner ear, which can affect balance.
B: Blurred vision, while it can be associated with hypertension, is not as directly related to essential hypertension as vertigo is. It is more commonly a sign of complications from prolonged uncontrolled hypertension.
C: Dyspnea or difficulty breathing is not typically a direct symptom of essential hypertension, though it can be a symptom of complications such as heart failure, which can be a result of long-standing, uncontrolled hypertension.
D: Uremia, which is an elevated level of waste products in the blood, is not a symptom of essential hypertension but rather a sign of kidney failure, which can be a secondary complication of chronic hypertension. Essential hypertension itself does not directly cause uremia.
A nurse is assessing a male client who has advanced peripheral artery disease (PAD). Which of the following findings should the nurse expect?
A. Thin, pliable toenails
Thin, pliable toenails are not a typical finding of PAD, but they may indicate a fungal infection or a normal aging process.
B. Hairy legs
Hairy legs are not a finding of PAD, but rather the opposite. Hair loss on the legs is a sign of PAD, due to the reduced blood supply to the hair follicles.
C. Leg pain at rest
feet or toes that occurs at night and is not relieved by rest.
D. Flushed, warm legs
Flushed, warm legs are not a finding of PAD, but rather a sign of inflammation, infection, or cellulitis.
Full Explanation
feet or toes that occurs at night and is not relieved by rest.
A nurse is performing a cardiac assessment on a client and auscultates an S3 sound. The nurse should recognize that this sound represents which of the following heart conditions?
A. Closure of pulmonic valve
Closure of pulmonic valve is one of the components of the S2 sound, which is a high-pitched sound heard at the end of systole, just before the S1 sound. It is caused by the closure of the semilunar valves (pulmonic and aortic).
B. Closure of the mitral valve
Closure of the mitral valve is one of the components of the S1 sound, which is a high-pitched sound heard at the beginning of systole, just after the S2 sound. It is caused by the closure of the atrioventricular valves (mitral and tricuspid).
C. Ventricular gallop
D. Atrial gallop
Atrial gallop is another name for the S4 sound, which is a low-pitched sound heard at the end of diastole, just before the S1 sound. It is caused by atrial contraction and increased resistance to ventricular filling.
Full Explanation
Ventricular gallop is another name for the S3 sound, which is a low-pitched sound heard at the end of diastole, just after the S2 sound. It is caused by the rapid filling of the ventricles and the vibration of the ventricular walls.
Closure of the pulmonic valve is one of the components of the S2 sound, which is a high-pitched sound heard at the end of the systole, just before the S1 sound. It is caused by the closure of the semilunar valves (pulmonic and aortic).
Closure of the mitral valve is one of the components of the S1 sound, which is a high-pitched sound heard at the beginning of systole, just after the S2 sound. It is caused by the closure of the atrioventricular valves (mitral and tricuspid).
d. Atrial gallop is another name for the S4 sound, which is a low-pitched sound heard at the end of diastole, just before the S1 sound. It is caused by atrial contraction and increased resistance to ventricular filling.