A 52-year-old male is diagnosed with chronic venous insufficiency, presenting with pooling of blood in the veins of the lower extremities and edema.
Which of the following is an expected assessment finding of this disorder?
Skin hyperpigmentation.
Gangrene.
Edema above the knee.
Deep vein thrombus formation.
The Correct Answer is A
Choice A rationale
Skin hyperpigmentation is a common symptom of chronic venous insufficiency. This happens because blood pools in the veins and can leak into the surrounding tissue, causing a change in skin color.
Choice B rationale
Gangrene is not a typical symptom of chronic venous insufficiency. Gangrene is a serious condition that occurs when tissue dies due to a lack of blood flow.
Choice C rationale
Edema, or swelling, is a common symptom of chronic venous insufficiency, but it typically occurs in the lower legs and ankles, not above the knee.
Choice D rationale
Deep vein thrombus formation is not a typical symptom of chronic venous insufficiency. However, a history of deep vein thrombosis can increase the risk of developing chronic venous insufficiency.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Anxiety is a common response to the stress of hospitalization and illness, especially in the context of a serious condition like ST-segment-elevation myocardial infarction (STEMI).
However, while anxiety can exacerbate physical symptoms and should be addressed, it is not the primary problem in this scenario.
Choice B rationale
Acute pain is a common symptom of STEMI, as the heart muscle is deprived of oxygen. However, the patient’s blood pressure and heart rate readings suggest a more immediate concern related to the cardiovascular system.
Choice C rationale
Decreased cardiac output is likely the priority problem for this patient. The patient’s low blood pressure (86/40 mm Hg) and high heart rate (132 beats/min) suggest that the heart is not pumping enough blood to meet the body’s needs, which is a direct consequence of the STEMI1. This can lead to organ failure and other serious complications if not addressed promptly.
Choice D rationale
Stress management is an important aspect of long-term care for patients with heart disease, as chronic stress can contribute to further heart damage. However, in the acute phase of a STEMI, the focus is on stabilizing the patient’s condition and preventing complications.
Correct Answer is A
Explanation
Choice A rationale
Left heart failure is a common cause of right heart failure. When the left side of the heart is unable to pump blood efficiently, it can cause increased pressure in the lungs, which can then lead to right heart failure.
Choice B rationale
Pericarditis, an inflammation of the sac-like covering around the heart, is not typically a direct cause of right heart failure.
Choice C rationale
While hypertension, or high blood pressure, can contribute to heart failure, it typically affects the left side of the heart more than the right.
Choice D rationale
Acute pneumonia, an infection that inflames the air sacs in one or both lungs, is not typically a direct cause of right heart failure.
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