The nurse is assessing a patient’s arteriovenous (AV) fistula. Which finding provides evidence of its normal function?
Pulselessness.
Ecchymotic area.
Redness.
Enlarged vein.
The Correct Answer is D
Choice A reason: Pulselessness is not a sign of normal AV fistula function; a palpable pulse should be present.
Choice B reason: An ecchymotic area suggests bruising and is not indicative of normal function.
Choice C reason: Redness may indicate inflammation or infection, not normal function.
Choice D reason: This is the correct choice. An enlarged vein is typical for an AV fistula and indicates good blood flow through the fistula.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Keeping alarm levels low is important to reduce stress and promote a healing environment, but it is not the most impactful intervention for personalized care.
Choice B reason: Dimming the lights at night helps maintain a normal sleep-wake cycle, which is beneficial but not as specific to the client's individual needs as continuity of care.
Choice C reason: Having the same nurses care for the patient on consecutive days can provide consistency and build trust, which is especially important for a child in critical condition.
Choice D reason: While visits from school friends can be uplifting, they may not be feasible or appropriate for a client in critical condition in the PICU. The priority is ensuring stable and consistent care.
Correct Answer is B
Explanation
Choice A reason: Fasciitis, inflammation of the fascia, could cause pain and possibly edema, but it typically does not cause fever.
Choice B reason: Compartment syndrome is a serious condition where increased pressure within the muscles can lead to muscle and nerve damage as well as problems with blood flow. Pain, edema, and fever could be signs of this condition, especially in a limb that is in traction.
Choice C reason: Osteochondrosis refers to a group of disorders that affect the growth of bones in children and adolescents. While it can cause pain, it does not typically cause edema or fever.
Choice D reason: Osteomyelitis, an infection in the bone, could cause pain, edema, and fever. However, the acute onset of symptoms in a limb under traction is more indicative of compartment syndrome. Osteomyelitis typically has a more gradual onset.
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