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A nurse is collecting data from a client who has respiratory insufficiency. Which of the following findings should the nurse identify as an early sign of inadequate oxygenation?

Cyanosis

Retractions

Restlessness

Diaphoresis

Answer and Explanation

The Correct Answer is C

A. Cyanosis:
Cyanosis is a late sign of hypoxia and indicates significant oxygen deficiency.

B. Retractions:
Retractions are a moderate to late sign of respiratory distress and increased work of breathing.

C. Restlessness:
Restlessness, anxiety, and irritability are early neurological signs of hypoxia.

D. Diaphoresis:
Diaphoresis may occur but is not as early or specific as restlessness in signaling hypoxia.

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Free Nursing Study Resources

Correct Answer is D

Explanation

A. Darkened skin color near extremities: More typical in venous disease, not PAD.

B. Warm extremities: PAD causes cool or cold extremities due to poor blood flow.

C. Edema: More common in venous insufficiency than in PAD.

D. Intermittent claudication: This is a hallmark symptom of PAD, causing leg pain during activity that resolves with rest.

A. "I will avoid crossing my legs at the knees." B. "I will not go barefoot and wear proper fitted shoes." C. "I will use a thermometer to check the temperature of my bath water." D. "I will wear stockings with tight elastic tops."

Correct Answer is D

Explanation

A. "I will avoid crossing my legs at the knees.":
Crossing legs can impair circulation and should be avoided in PVD.

B. "I will not go barefoot and wear proper fitted shoes.":
Clients with PVD are at high risk for injury and infection, so proper foot protection is important.

C. "I will use a thermometer to check the temperature of my bath water.":
Clients with PVD may have decreased sensation and should check water temperature to avoid burns.

D. "I will wear stockings with tight elastic tops.":
Tight elastic can constrict circulation. Compression stockings may be used, but not ones with tight bands that can impair venous return.

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A nurse is collecting data from a client who has respiratory insufficiency. Which of the following findings should the nurse identify as an early sign of inadequate oxygenation?

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Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a client who has peripheral arterial disease (PAD). Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

A nurse is reinforcing teaching with a client who has peripheral vascular disease (PVD). The nurse should recognize that which of the following statements by the client indicates a need for further teaching?

Correct Answer is D

Explanation

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