During the physical assessment of the peripheral vascular system, a client's foot is pale when elevated and dark red when in the dependent position. The nurse is concerned that this client is at risk for developing:

Venous insufficiency ulcers

Arterial insufficiency ulcers

Neuropathic ulcers

Deep vein thrombosis

Answer and Explanation

The Correct Answer is B

A. Venous insufficiency ulcers: Typically present with dark discoloration and edema, but not specifically with changes in color with elevation and dependency.

B. Arterial insufficiency ulcers: Pale feet when elevated and dark red when dependent are classic signs of arterial insufficiency. These changes in color are due to poor blood flow.

C. Neuropathic ulcers: Usually associated with diabetes and often occur on pressure points, not typically related to color changes with elevation.

D. Deep vein thrombosis: While DVT can cause swelling and pain, it does not usually present with color changes that are dependent on the position of the foot.

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Correct Answer is B

Explanation

A. Chest pain: This symptom is important but does not specifically correlate with difficulty sleeping unless upright.

B. Orthopnea: Difficulty breathing while lying flat (orthopnea) is typically associated with heart failure and would require further investigation to understand its impact on the client's sleep.

C. Edema: While edema can be a sign of cardiovascular problems, it does not directly explain the difficulty in sleeping unless in an upright position.

D. Palpitations: Palpitations might affect sleep but are less directly linked to the need to sleep upright compared to orthopnea.

A. Pulmonic and tricuspid B. Mitral and aortic C. Aortic and pulmonic D. Tricuspid and mitral

Correct Answer is C

Explanation

A. Pulmonic and tricuspid: The tricuspid valve's closure is not primarily audible at the 2nd intercostal space right sternal border; it is better heard at the lower left sternal border.

B. Mitral and aortic: The mitral valve is best heard at the apex of the heart, not the 2nd intercostal space right sternal border.

C. Aortic and pulmonic: The 2nd intercostal space right sternal border is the area where the aortic and pulmonic valves are auscultated. The louder S2 here indicates the closure of these valves, with the aortic valve being the primary source of sound in this area.

D. Tricuspid and mitral: These valves are best heard at other locations, with the tricuspid valve near the lower left sternal border and the mitral valve at the apex.

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During the physical assessment of the peripheral vascular system, a client's foot is pale when elevated and dark red when in the dependent position. The nurse is concerned that this client is at risk for developing:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While completing the cardiovascular system health history, a client reports difficulty falling asleep unless she is in an upright position. Which of the following potential problems should the nurse further investigate?

Correct Answer is B

Explanation

When auscultating a client's heart sounds, the nurse hears a louder S2 when listening at the 2nd intercostal space right sternal border. The nurse determines that this finding is consistent with the closure of which heart valves?

Correct Answer is C

Explanation

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