A client drove himself to the urgent care center for Legs that look like balloons and difficulty walking. The nurse assesses 4+ edema of both legs based upon which finding?

Very deep pitting indentation of legs lasts several minutes.

Deep pitting indentation of legs lasts a few minutes.

Mild pitting no perceptible swelling of the legs.

Moderate pitting: indentation of legs subsides rapidly.

Answer and Explanation

The Correct Answer is A

Choice A rationale: 4+ edema is characterized by very deep pitting indentation of the legs that lasts several minutes. This indicates severe fluid retention and significant swelling.

Choice B rationale: Deep pitting indentation lasting a few minutes is more indicative of 2+ or 3+ edema, not 4+.

Choice C rationale: Mild pitting with no perceptible swelling is more indicative of 1+ edema, not 4+.

Choice D rationale: Moderate pitting with rapid subsidence is indicative of 3+ edema, not 4+.

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Correct Answer is A

Explanation

Choice A rationale: Severe bilateral lower extremity edema is commonly associated with heart failure. In heart failure, the heart's ability to pump blood is compromised, leading to fluid retention and peripheral edema.

Choice B rationale: Excess fluid retention is more of a symptom rather than an underlying cause. Heart failure is a condition that can lead to fluid retention.

Choice C rationale: Excess fluid consumption is unlikely to be the primary cause of severe bilateral lower extremity edema. Underlying medical conditions, such as heart failure, are more likely.

Choice D rationale: While a pulmonary embolism can lead to cardiovascular compromise, severe bilateral lower extremity edema is more commonly associated with heart failure.

A. "With aging, a large amount of subcutaneous fat is lost, which gives the appearance of decreased height." B. "With aging, the spine is not as flexible, which doesn't permit the individual to stand as tall." C. "With aging, the cartilage between the bones in the spine gets worn down, which causes decreased height." D. "With aging, thickening of the intervertebral disks occurs, which causes pressure breakdown of the spinal vertebrae."

Correct Answer is C

Explanation

Choice A rationale: Loss of subcutaneous fat is not a primary factor contributing to decreased height with aging.

Choice B rationale: The flexibility of the spine may contribute to posture but is not the primary reason for a significant decrease in height.

Choice C rationale: With aging, the cartilage between the bones in the spine gets worn down, leading to decreased height. This is due to degenerative changes in the intervertebral disks.

Choice D rationale: Thickening of intervertebral disks is not typically associated with aging and decreased height. Degeneration and thinning of the disks are more common factors.

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A client drove himself to the urgent care center for Legs that look like balloons and difficulty walking. The nurse assesses 4+ edema of both legs based upon which finding?

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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