The nurse is caring for a client with weak pedal pulses, absent hair on bilateral legs, and a full-thickness wound on the right lateral malleolus with defined margins, including a minimal amount of serous exudate.

Which of the following interventions is contraindicated?

Assess the need for smoking cessation.

Apply TED hose to bilateral legs.

Consult physical therapy.

Obtain Ankle-Brachial Index (ABI) with a hand-held Doppler.

Answer and Explanation

The Correct Answer is B

Choice A rationale
Assessing the need for smoking cessation is a standard part of nursing care, especially for patients with circulatory issues. Smoking can exacerbate circulatory problems and delay wound healing.
Choice B rationale
Applying TED hose to bilateral legs might not be appropriate for this patient. TED hose are compression stockings designed to prevent deep vein thrombosis and promote circulation.
However, in a patient with weak pedal pulses and a full-thickness wound on the leg, the compression from the stockings could potentially worsen circulation to the area and impede wound healing.
Choice C rationale
Consulting physical therapy could be beneficial for this patient. Physical therapists can provide exercises and interventions to improve circulation and mobility, which could help with the patient’s circulatory issues and wound healing.
Choice D rationale
Obtaining an Ankle-Brachial Index (ABI) with a hand-held Doppler could be useful in this situation. The ABI is a simple, non-invasive test that can help diagnose peripheral artery disease (PAD), a condition that could be causing the patient’s weak pedal pulses and wound healing issues.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A rationale
Bradycardia, palpitations, confusion, and truncal rash are not typically associated with septic shock. Septic shock is a severe infection that occurs when bacteria enter the bloodstream. It can cause organs to fail and can lead to death.
Choice B rationale
Severe respiratory distress, jugular venous distention, and chest pain are more commonly associated with conditions like heart failure or pulmonary embolism, not septic shock.
Choice C rationale
Low blood pressure and tachycardia are common symptoms of septic shock. This happens because the body’s response to the infection causes blood vessels to dilate, which can lower blood pressure. The heart rate often increases (tachycardia) in an attempt to maintain blood flow to the organs.
Choice D rationale
Reduced cardiac output, increased systemic vascular resistance, and a moist cough are not typical symptoms of septic shock. These symptoms are more commonly associated with conditions like heart failure.

A. Exercise electrocardiography. B. Computed tomography (CT) of the chest with contrast. C. Echocardiogram. D. Percutaneous coronary intervention (PCI).

Correct Answer is D

Explanation

Choice A rationale
Exercise electrocardiography, also known as a stress test, is not typically the first-line emergent procedure for a patient with an acute myocardial infarction (AMI). This test is often used to diagnose coronary artery disease, but it is not typically used to treat an AMI5.
Choice B rationale
A computed tomography (CT) scan of the chest with contrast could be used to visualize the heart and surrounding structures, but it is not typically the first-line emergent procedure for a patient with an AMI5.
Choice C rationale
An echocardiogram could be used to visualize the heart’s structure and function, but it is not typically the first-line emergent procedure for a patient with an AMI5.
Choice D rationale
Percutaneous coronary intervention (PCI) is the correct answer. This procedure is often used as an emergent treatment for an AMI. It involves using a catheter to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse is caring for a client with weak pedal pulses, absent hair on bilateral legs, and a full-thickness wound on the right lateral malleolus with defined margins, including a minimal amount of serous exudate. Which of the following interventions is contraindicated?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 20-year-old female is being admitted to the hospital with fever and septic shock. Which set of assessment findings would the nurse expect the patient to exhibit?

Correct Answer is C

Explanation

The nurse is caring for a client with an acute myocardial infarction (AMI). What emergent procedure does the nurse anticipate the physician will order?

Correct Answer is D

Explanation

A 52-year-old male is diagnosed with chronic venous insufficiency, presenting with pooling of blood in the veins of the lower extremities and edema. Which of the following is an expected assessment finding of this disorder?

The nurse is conducting a physical assessment on a client with infective endocarditis (IE). The nurse observes flat, reddened, non-tender maculae on the hands and feet. What does the nurse understand these to be?

A woman has recently been diagnosed with Raynaud’s disease. What important information should the nurse provide to this patient?

A patient is being admitted to the emergency department with intermittent chest pain. They provide a list of daily medications. Which medication from the list has the most immediate implications for the patient’s care?

The nurse is providing care for a patient with the following tracing on the electrocardiogram (ECG) for atrial fibrillation. What prescription should the nurse anticipate from the primary healthcare provider (PHCP)?

As a nurse in a community-based setting, you are educating clients on strategies to prevent cardiovascular disease. Which interventions should you include? (Select all that apply)

A patient with dilated cardiomyopathy has recently developed atrial fibrillation that has been unresponsive to drug therapy for several days. What topic should the nurse plan to include in patient teaching?

When caring for a client who has developed cardiac tamponade, what assessments should the nurse expect to find?

The nurse is caring for a client with weak pedal pulses, absent hair on bilateral legs, and a full-thickness wound on the right lateral malleolus with defined margins, including a minimal amount of serous exudate.

Which of the following interventions is contraindicated?