The nurse is caring for a 3-year-old client who is two hours postoperative from a cardiac catheterization via the right femoral artery. Which assessment finding is an indication of arterial obstruction?

The pressure dressing at right femoral area is moist and oozing blood.

Pulse distal to the femoral artery is weaker on left foot than right foot.

Right foot is cool to the touch and appears pale and blanched.

Blood pressure trend is downward and pulse is rapid and irregular.

Answer and Explanation

The Correct Answer is C

A. While bleeding can occur postoperatively from the catheter insertion site, it is more indicative of venous or capillary bleeding rather than arterial obstruction. Arterial obstruction typically presents with signs related to decreased arterial blood flow rather than external bleeding.

B. This finding suggests a difference in peripheral pulses between the two lower extremities. While it could indicate arterial compromise, the question specifically asks about arterial obstruction at the site of the catheterization (right femoral artery).

C. This finding is concerning for arterial obstruction. Coolness, pallor, and blanching of the right foot indicate decreased arterial blood flow to the extremity. Arterial obstruction can lead to reduced perfusion distal to the occlusion site, resulting in these clinical signs.

D. These vital sign changes could indicate systemic complications, such as shock, rather than isolated arterial obstruction at the femoral artery site. While systemic changes can occur secondary to arterial obstruction, they are not specific indicators of obstruction at the femoral artery.

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Correct Answer is B

Explanation

Rationale

A. Benzodiazepine antagonists, such as flumazenil, are used to reverse the effects of benzodiazepines in cases of overdose or excessive sedation. However, in the context of using temazepam for insomnia, this is not a standard approach.

B. Benzodiazepines like temazepam should not be stopped abruptly, especially if they have been taken regularly. Abrupt cessation can lead to withdrawal symptoms, including rebound insomnia, anxiety, agitation, and potentially seizures in severe cases.

C. This option addresses the symptom of feeling "hungover" or fatigued the next day after taking temazepam. It acknowledges that residual sedation or drowsiness can occur with temazepam use. The nurse can educate the client about the potential for these side effects and suggest allowing for adequate time for sleep to alleviate these symptoms.

D. Stopping temazepam abruptly is not recommended because it can lead to withdrawal symptoms and potentially worsen insomnia. This option does not address the need for tapering off the medication or managing the symptoms effectively.

A. Neurology unit supervisor. B. Nurse case manager. C. Adult nurse practitioner. D. Risk management nurse.

Correct Answer is B

Explanation

Rationale

A. This role oversees the neurology unit but may not be directly involved in ICU care coordination, which requires a focus on acute management and transition to rehabilitation.

B. Nurse case managers are skilled in coordinating care for patients with complex conditions, ensuring continuity of care, and facilitating communication among healthcare providers and the client's family.

C. While an NP may be involved in direct patient care, their role is more focused on clinical management rather than comprehensive care coordination across different disciplines.

D. This role deals with patient safety and risk reduction but is not primarily responsible for coordinating care for a specific patient's acute medical needs and rehabilitation planning.

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The nurse is caring for a 3-year-old client who is two hours postoperative from a cardiac catheterization via the right femoral artery. Which assessment finding is an indication of arterial obstruction?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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