A nurse is caring for a client with a suspected aneurysm. Which of the following assessments should the nurse prioritize to monitor for potential rupture?

Pain level assessment

Blood pressure measurement

Respiratory rate evaluation

Urinary output monitoring

Answer and Explanation

The Correct Answer is A

A) Correct - Pain level assessment is essential in monitoring for aneurysm rupture because sudden, severe, and persistent pain is a common manifestation. It could indicate that the aneurysm is leaking or has ruptured, requiring immediate medical attention.

B) Incorrect - While blood pressure measurement is important in managing aneurysm, it may not be the best indicator of an imminent rupture. Some aneurysms are asymptomatic until they rupture.

C) Incorrect - Respiratory rate evaluation is not a primary assessment for aneurysm rupture. Although respiratory distress may occur due to pain or compromised blood flow after rupture, it is not the initial priority.

D) Incorrect - While monitoring urinary output is important in various clinical settings, it is not a priority assessment for aneurysm rupture. There are more specific symptoms related to aneurysm rupture that the nurse should focus on.

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Correct Answer is D

Explanation

A) Incorrect - While angioplasty may be effective for some cases of PAD, it is not always the best treatment option and may not be suitable for everyone.

B) Incorrect - Surgical bypass grafting is an option for severe cases of PAD, but it may not be the most effective treatment for all clients.

C) Incorrect - Amputation is considered a last resort for PAD and is only considered when all other treatment options have been exhausted and the limb is at risk for gangrene or life-threatening complications.

D) Correct - Medical management with lifestyle changes, such as quitting smoking, controlling blood pressure and cholesterol levels, and regular exercise, is often the first-line treatment for PAD. This approach aims to improve blood flow and manage symptoms before considering more invasive interventions.

A. History of migraines B. Exposure to cold temperatures C. Hypercholesterolemia D. Family history of diabetes

Correct Answer is C

Explanation

A) Incorrect - A history of migraines is not a risk factor for peripheral artery disease. PAD is primarily associated with atherosclerosis and arterial occlusion.

B) Incorrect - Exposure to cold temperatures can exacerbate symptoms in individuals with PAD, but it is not a primary risk factor for the development of the condition.

C) Correct - Hypercholesterolemia (high cholesterol levels) is a significant risk factor for PAD. Elevated cholesterol can contribute to atherosclerosis and the narrowing of peripheral arteries.

D) Incorrect - While family history can be important in assessing an individual's overall risk for various diseases, it is not a direct risk factor for PAD. Diabetes itself is a risk factor for PAD, not its family history.

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A nurse is caring for a client with a suspected aneurysm. Which of the following assessments should the nurse prioritize to monitor for potential rupture?

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Naxlex Comprehensive Predictor Exams

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