The nurse is assessing a client who reports pain to the left lower extremity, especially while ambulating. The discomfort is relieved with rest. Assessment findings confirm left lower leg mottling and hairlessness. Which health problem will the nurse most likely include in the planning of the client's care?
Peripheral vascular disease
Coronary artery disease
Right sided heart failure
Arterial embolism
The Correct Answer is A
A. Peripheral vascular disease: Intermittent claudication, or pain that occurs during ambulation and is relieved by rest, is a hallmark of arterial insufficiency. Mottling and hairlessness are objective signs of chronic tissue ischemia due to reduced peripheral blood flow. These findings indicate that the arterial supply is failing to meet the metabolic demands of the lower extremity.
B. Coronary artery disease: This condition involves the narrowing of the arteries supplying the heart muscle, typically presenting as chest pain or angina. While it shares the same underlying atherosclerotic process as peripheral vascular disease, it does not directly cause leg mottling or hairlessness. The client’s specific symptoms are localized to the peripheral rather than the cardiac circulation.
C. Right sided heart failure: Right-sided failure primarily manifests as systemic venous congestion, leading to jugular venous distention and dependent edema. It does not typically cause intermittent claudication or the skin changes associated with arterial deprivation. While it affects the lower extremities, it presents with swelling rather than mottling and hair loss.
D. Arterial embolism: An acute embolism usually presents with the "six Ps," including sudden, severe pain, pulselessness, and pallor. The client's report of intermittent pain relieved by rest suggests a chronic, progressive narrowing rather than an acute, total occlusion. An embolism is an emergency that would not typically be relieved simply by resting.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["320"]
Explanation
Standard conversions:
- 1 cup = 240 mL
- 1 oz = 30 mL
Step 1: Convert Breakfast Intake
1 cup coffee
240 mL
4 oz milk
4 × 30 = 120 mL
Breakfast total:
240 + 120 = 360 mL
Step 2: Convert Lunch Intake
12 oz diet soda
12 × 30 = 360 mL
1½ cups chicken soup
1.5 × 240 = 360 mL
Lunch total:
360 + 360 = 720 mL
Step 3: Convert Dinner Intake
16 oz lemonade
16 × 30 = 480 mL
4 oz Jello
4 × 30 = 120 mL
Dinner total:
480 + 120 = 600 mL
Step 4: Calculate Total Intake
360 + 720 + 600 = 1680 mL
Step 5: Subtract From Fluid Restriction
2000 − 1680 = 320 mL
Correct Answer is B
Explanation
A. Hypothyroidism: While the client has a history of hypothyroidism, the clinical presentation of visual disturbances and profound bradycardia is not typical of a thyroid deficit. Low thyroid hormone levels usually present with weight gain, cold intolerance, and dry skin rather than greenish halos. The dose of 25 mcg is a standard replacement and does not explain the acute confusion or visual changes.
B. Digoxin toxicity: The combination of bradycardia with a heart rate of 44, greenish-yellow visual halos, and new-onset confusion are classic signs of digitalis overdose. Furosemide use often leads to hypokalemia, which significantly sensitizes the myocardium to the toxic effects of digoxin. A dose of 0.5 mg is also relatively high, increasing the risk of systemic accumulation and toxic side effects.
C. Glaucoma: This ocular condition causes increased intraocular pressure and can lead to vision loss or seeing halos around lights. However, glaucoma does not cause systemic symptoms like profound bradycardia, confusion, or gastrointestinal disturbances such as constipation. The visual symptoms in this case are a secondary manifestation of a systemic pharmacological toxicity rather than a primary eye disease.
D. Unstable angina: Unstable angina presents with crescendo chest pain at rest and is often associated with EKG changes or hemodynamic instability. It does not typically manifest with bradycardia, constipation, or the characteristic visual disturbances described in the stem. The client's symptoms point toward a metabolic or drug-induced etiology rather than acute coronary artery narrowing.
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