When developing a teaching plan for a client with peripheral artery disease, the nurse should explain that intermittent claudication occurs as the result of which underlying pathophysiology?

Reduced blood flow occurs when legs are elevated.

Reddened color occurs when the feet are dependent.

Arterial occlusion causes ischemic pain during activity.

Reduction in blood supply leads to muscle atrophy.

Answer and Explanation

The Correct Answer is C

Intermittent claudication is a common symptom experienced by individuals with peripheral artery disease (PAD). It occurs due to the underlying pathophysiology of arterial occlusion and ischemia during physical activity. Here's why option C is the correct choice:

A) Reduced blood flow occurs when legs are elevated:

This statement is not accurate regarding the pathophysiology of intermittent claudication in PAD. When legs are elevated, gravity assists venous return, which may actually improve blood flow temporarily. However, intermittent claudication occurs during activity, not when the legs are elevated.

B) Reddened color occurs when the feet are dependent:

This statement is unrelated to the pathophysiology of intermittent claudication. Redness when the feet are dependent may suggest venous insufficiency rather than arterial occlusion characteristic of PAD.

C) Arterial occlusion causes ischemic pain during activity:

Correct. Intermittent claudication is caused by inadequate blood flow to the muscles during physical activity due to arterial occlusion in PAD. As the demand for oxygen increases during exercise, the narrowed arteries cannot supply sufficient blood flow, leading to ischemic pain in the affected muscles. This pain typically resolves with rest and recurs upon resuming activity.

D) Reduction in blood supply leads to muscle atrophy:

Muscle atrophy may occur in severe cases of PAD with chronic ischemia, but it is not the primary cause of intermittent claudication. Intermittent claudication is primarily attributed to inadequate blood flow during activity, which results in ischemic pain rather than muscle atrophy.

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Correct Answer is C

Explanation

Disseminated intravascular coagulation (DIC) is a serious condition characterized by widespread activation of coagulation throughout the body, leading to both thrombosis and hemorrhage. Here's why option C is the correct choice:

A) Glucosuria and lethargy:

Glucosuria (presence of glucose in the urine) and lethargy are not typical findings associated with DIC. Glucosuria may indicate diabetes mellitus or renal dysfunction, while lethargy can result from various causes but is not specific to DIC.

B) Frothy urine and anorexia:

Frothy urine may indicate proteinuria, which can occur in conditions such as nephrotic syndrome, but it is not a characteristic finding of DIC. Anorexia (loss of appetite) is a nonspecific symptom that can occur in many conditions but is not directly related to DIC.

C) Hematuria and hemoptysis:

Correct. Hematuria (blood in the urine) and hemoptysis (coughing up blood) are common manifestations of DIC. In DIC, widespread activation of the coagulation cascade can lead to microthrombi formation in small blood vessels, resulting in tissue ischemia and bleeding. Hematuria and hemoptysis can occur due to bleeding from the urinary tract or respiratory system, respectively, as a result of DIC-induced coagulopathy.

D) Polyuria and productive cough:

Polyuria (excessive urination) and productive cough (cough with production of sputum) are not specific findings of DIC. Polyuria may occur in conditions such as diabetes mellitus or diuretic use, while productive cough can be seen in respiratory infections or chronic lung diseases but is not directly related to DIC.

A. Embolic migration. B. Massive atelectasis C. Respiratory failure. D. Pulmonary infarction.

Correct Answer is C

Explanation

The ABG results indicate respiratory acidosis (pH 7.0, PaCO2 66 mmHg) with compensatory metabolic alkalosis (HCO3- 24 mEq/L). The low PaO2 (60 mmHg) suggests hypoxemia.

pH 7.0: The pH is below the normal range (7.35 to 7.45), indicating acidosis.

PaCO2 66 mmHg: The PaCO2 is elevated above the normal range (35 to 45 mmHg), indicating respiratory acidosis.

HCO3- 24 mEq/L: The bicarbonate level is within the normal range (21 to 28 mEq/L), indicating compensatory metabolic alkalosis.

PaO2 60 mmHg: The PaO2 is decreased below the normal range (80 to 100 mmHg), indicating hypoxemia.

These findings suggest that the client is experiencing respiratory failure, which is characterized by inadequate gas exchange resulting in hypoxemia and hypercapnia. In this case, the massive pulmonary embolus is causing ventilation-perfusion (V/Q) mismatch, leading to impaired gas exchange and respiratory compromise. Tachycardia, hypotension, and audible bilateral pulmonary crackles further support the diagnosis of respiratory failure in the context of a massive pulmonary embolus.

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When developing a teaching plan for a client with peripheral artery disease, the nurse should explain that intermittent claudication occurs as the result of which underlying pathophysiology?

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