The nurse is evaluating a client with multiple cardiovascular risk factors. Which of the following assessment findings would be most indicative of chronic venous insufficiency?

Bilateral lower extremity reddening when legs are dangled in a dependent position.

Shiny white skin with "hole-punch" ulcers.

Leathery brown skin with irregular ulcers over the ankles.

Red, swollen, tender area to one calf.

Answer and Explanation

The Correct Answer is C

A. Bilateral lower extremity reddening when legs are dangled could be seen in other conditions like deep vein thrombosis (DVT) but is not typical of CVI.

B. Shiny white skin with "hole-punch" ulcers is more characteristic of arterial insufficiency rather than venous insufficiency.

C. Chronic venous insufficiency (CVI) is characterized by impaired venous return, which leads to fluid buildup, skin changes, and ulcer formation. The skin becomes leathery and brown due to hemosiderin deposition from blood pooling in the lower extremities. Ulcers often occur around the ankles and have irregular borders.

D. Red, swollen, tender areas in one calf are more indicative of DVT, not chronic venous insufficiency.

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Correct Answer is D

Explanation

A. Cutting toenails straight across is an appropriate action for PAD clients because it prevents injury or infection, as clipping nails too short or rounding the edges can cause cuts or ingrown nails.

B. Wearing shoes and socks instead of open-toed shoes is recommended to protect the feet from injury, as individuals with PAD have decreased sensation in their feet, increasing the risk of unnoticed injury.

C. Inspecting the feet daily for cuts is a crucial step in PAD management to detect early signs of infection or injury, which can lead to complications such as gangrene or amputation.

D. Raising the legs above the heart level can worsen symptoms in PAD by further reducing arterial blood flow to the lower extremities, where circulation is already compromised. This technique is typically used in venous insufficiency, not PAD.

A. AST and ALT B. Prothrombin time (PT) C. Activated partial thromboplastin time (aPTT) D. International normalized ratio (INR)

Correct Answer is C

Explanation

A. AST and ALT are liver enzymes, primarily used to assess liver function, not directly related to monitoring heparin therapy.

B. Prothrombin time (PT) is used to monitor warfarin therapy, not heparin. Heparin therapy is typically monitored with aPTT, whereas warfarin is monitored with PT/INR.

C. Heparin is an anticoagulant that works by inhibiting clotting factors, and the aPTT is used to monitor its effectiveness. The aPTT measures the time it takes for blood to clot and helps ensure the heparin dose is therapeutic without causing excessive bleeding. The typical therapeutic range for aPTT on heparin therapy is 1.5 to 2.5 times the normal value.

D. INR is used to monitor warfarin therapy, not heparin. Heparin does not affect INR levels.

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The nurse is evaluating a client with multiple cardiovascular risk factors. Which of the following assessment findings would be most indicative of chronic venous insufficiency?

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