The nurse is performing a physical assessment of a client. Which finding should the nurse recognize is a result of a compromised peripheral arterial circulation of the lower extremity?

Bronze pigmentation.

Lower leg edema.

Uneven hair distribution.

Bounding peripheral pulse.

Answer and Explanation

The Correct Answer is C

A. Bronze pigmentation is not typically associated with compromised peripheral arterial circulation but may be seen in conditions like hemochromatosis.

B. Lower leg edema is more commonly associated with venous insufficiency rather than compromised arterial circulation.

C. Uneven hair distribution, such as decreased hair growth on the lower extremity, is indicative of compromised peripheral arterial circulation due to reduced blood flow to the area.

D. Bounding peripheral pulse is not typically associated with compromised peripheral arterial circulation but may indicate increased stroke volume or arterial stiffness.

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Correct Answer is A

Explanation

A. Assessing the pin sites for signs of infection is essential in clients with skeletal traction to detect any early signs of infection, such as redness, swelling, warmth, or purulent drainage. Prompt identification and management of pin site infections can prevent complications.

B. Administering pain medication at designated intervals around the clock helps to ensure adequate pain control and comfort for the client. However, this intervention alone does not specifically address the care needs related to skeletal traction.

C. Assessing the pulses proximal to the fracture site is important for monitoring circulation and detecting any signs of impaired perfusion. However, this assessment is not directly related to the care of skeletal traction itself.

D. Removing traction every shift is not indicated unless there is a specific reason to do so as ordered by the healthcare provider. Continuous traction is often necessary for proper alignment and stabilization of the fracture. Additionally, providing skin care is important to prevent skin breakdown around the traction device, but removing traction every shift is not part of routine care.

A. Hemoglobin levels. B. White blood cell count. C. Red blood cell count. D. Platelet count.

Correct Answer is D

Explanation

A. Hemoglobin levels primarily indicate the oxygen-carrying capacity of the blood and are not typically affected in conditions associated with petechiae and ecchymosis.

B. White blood cell count may be elevated in response to infection but is not directly related to the presence of petechiae and ecchymosis.

C. Red blood cell count primarily reflects the oxygen-carrying capacity of the blood and is not typically affected in conditions associated with petechiae and ecchymosis.

D. Platelet count is crucial in assessing for thrombocytopenia, a condition characterized by low platelet levels, which can lead to increased bleeding and bruising, including petechiae and ecchymosis.

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The nurse is performing a physical assessment of a client. Which finding should the nurse recognize is a result of a compromised peripheral arterial circulation of the lower extremity?

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Naxlex Comprehensive Predictor Exams

A client with a fracture of the right femur has had skeletal traction applied. Which intervention should the nurse include in the client's nursing care plan?

Correct Answer is A

Explanation

The nurse assesses a client with petechiae and ecchymosis scattered across the arms and legs. Which laboratory result should the nurse review?

Correct Answer is D

Explanation

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