A client with obstructive sleep apnea (OSA) calls the clinic to report difficulty wearing the continuous positive air pressure (CPAP) mask because it is uncomfortable. The client asks the nurse for an alternative way to manage sleep apnea. Which recommendation should the nurse provide?

a) Basic metabolic panel: This is a blood test that measures the levels of electrolytes, glucose, calcium, and kidney function. It is not a priority order for this client because her glucose level is within the normal range and her symptoms are not indicative of electrolyte imbalance or kidney failure.

b) Echocardiogram: This is a test that uses sound waves to create images of the heart and its valves, chambers, and blood flow. It is not a priority order for this client because her chest discomfort may not be related to a cardiac problem and her SpO2 is normal, indicating adequate oxygenation.

c) CT scan of abdomen: This is a test that uses X-rays to create detailed pictures of the organs and structures in the abdomen. It is not a priority order for this client because her abdominal pain is not severe or acute and her nausea and poor appetite may be due to her illness or dialysis.

d) Blood cultures times 2 sets: This is a test that checks for the presence of bacteria or fungi in the blood. It is not a priority order for this client because she does not have signs of infection such as fever, chills, or leukocytosis.

e) Chest X-ray: This is a test that uses X-rays to create images of the lungs and chest wall. It is not a priority order for this client because she does not have respiratory symptoms such as cough, shortness of breath, or wheezes.

f) Place on continuous cardiac monitor: This is an order that requires the nurse to attach electrodes to the client's chest and monitor the heart rate and rhythm continuously. This is a priority order for this client because she has a history of CAD and HTN and reports chest discomfort and lightheadedness, which could indicate a possible myocardial infarction (heart attack) or arrhythmia (irregular heartbeat).

g) CBC: This is a blood test that measures the number and types of blood cells, such as red blood cells, white blood cells, and platelets. It is not a priority order for this client because she does not have signs of anemia, bleeding, or infection.

h) 12 lead EKG: This is a test that records the electrical activity of the heart from 12 different angles. It can detect abnormalities in the heart's rhythm, conduction, or damage. This is a priority order for this client because she has a history of CAD and HTN and reports chest discomfort and lightheadedness, which could indicate a possible myocardial infarction (heart attack) or arrhythmia (irregular heartbeat).

Choice A reason: Irregular ulcer shapes and severe edema are characteristic of venous ulcers, which are caused by impaired venous return and increased capillary pressure. Venous ulcers are usually located near the medial malleolus and have a shallow depth.

Choice B reason: Hairless lower extremities and cool feet are signs of arterial insufficiency, which reduces blood flow and oxygen delivery to the tissues. Arterial ulcers are usually located on the toes, heels, or lateral malleoli and have a deep, punched-out appearance.

Choice C reason: Black ulcers and dependent rubor are also signs of arterial insufficiency, indicating tissue necrosis and inflammation. Dependent rubor is a reddish-blue color of the lower extremity that occurs when the leg is lowered below the level of the heart.

Choice D reason: Absent pedal pulses and shiny skin are also signs of arterial insufficiency, indicating reduced blood flow and atrophy of the skin. The skin may also be dry, scaly, or cracked.