A nurse is caring for a patient who has peripheral arterial disease (PAD). What symptoms should the nurse expect to find in the early stage of the disease?

Intermittent claudication

Foot ulcers

Pain at rest

Dependent rubor

Answer and Explanation

The Correct Answer is A

Choice A rationale

Intermittent claudication, which involves limb pain or cramping that generally begins when exercising and improves while resting, is a common symptom in the early stages of PAD5.

Choice B rationale

Foot ulcers are not typically a symptom of the early stages of PAD. They are more likely to occur in the later stages of the disease when blood flow to the extremities is significantly reduced.

Choice C rationale

Pain at rest is not typically a symptom of the early stages of PAD. It is more likely to occur in the later stages of the disease when blood flow to the extremities is significantly reduced.

Choice D rationale

Dependent rubor is not typically a symptom of the early stages of PAD. It is more likely to occur in the later stages of the disease when blood flow to the extremities is significantly reduced.

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Correct Answer is A

Explanation

Choice A rationale

When a patient is informed about a serious diagnosis like breast cancer and the need for a mastectomy, it is common for them to experience a range of emotions, including sadness, fear, and anxiety. As a nurse, providing emotional support and creating a safe space for the patient to express their feelings is crucial. Offering to be there for the patient if they want to talk acknowledges their emotional distress and provides comfort.

Choice B rationale

Asking the patient why they are upset may come across as insensitive or dismissive. The patient has just received a life-changing diagnosis, and their emotional reaction is completely normal and expected. It’s important to provide support and empathy rather than questioning their feelings.

Choice C rationale

Telling the patient that everything will be alright and there is no need to cry may seem comforting, but it can actually invalidate the patient’s feelings. It’s important to acknowledge the patient’s emotions and allow them to express their feelings without judgment.

Choice D rationale

Telling the patient that they will recover may be seen as providing false reassurance. While it’s important to maintain hope, it’s also crucial to be honest and realistic with the patient about their diagnosis and treatment.

A. The client will verbalize an understanding of appropriate foot care measures by discharge. B. The client will verbalize the importance of taking anti-platelet medications by discharge. C. The client will discuss exercises that promote healing of wounds prior to discharge. D. The client will recognize the need for an amputation in the near future.

Correct Answer is A

Explanation

Choice A rationale

The client diagnosed with peripheral arterial disease has impaired tissue integrity related to ischemic tissue of the legs and feet. This condition is often caused by factors such as physical trauma, thermal factors, chemical injury, infection, nutritional imbalances, fluid imbalances, and altered circulation. The most appropriate outcome to include in the care plan would be for the client to verbalize an understanding of appropriate foot care measures by discharge. This is because maintaining skin integrity and providing effective wound care are crucial aspects of managing this condition. By understanding and implementing appropriate foot care measures, the client can help prevent further tissue damage, promote healing, and improve their overall quality of life.

Choice B rationale

While taking anti-platelet medications can be an important part of managing peripheral arterial disease, it may not directly address the nursing problem of impaired tissue integrity. Anti-platelet medications can help prevent blood clots and improve blood flow, but they do not directly promote wound healing or tissue regeneration.

Choice C rationale

Discussing exercises that promote healing of wounds can be beneficial for the client. However, it’s important to note that exercises should be appropriate for the client’s condition and overall health status. Overexertion or inappropriate exercises could potentially exacerbate the condition and further impair tissue integrity.

Choice D rationale

Recognizing the need for an amputation in the near future can be a realistic outcome for some clients with severe peripheral arterial disease. However, this is typically considered a last resort when all other treatment options have failed. It’s also a drastic measure that can significantly impact the client’s quality of life.

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A nurse is caring for a patient who has peripheral arterial disease (PAD). What symptoms should the nurse expect to find in the early stage of the disease?

Choice B rationale

Choice C rationale

Choice D rationale

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The physician has just informed a patient that they have breast cancer and will require a mastectomy. The nurse finds that the patient is crying. Which response by the nurse is most appropriate?

Correct Answer is A

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

A client diagnosed with peripheral arterial disease has the nursing problem of Impaired Tissue Integrity related to ischemic tissue of the legs and feet. What is an expected outcome to include in the care plan?

Correct Answer is A

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

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