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A nurse is collecting data from a client who has peripheral arterial disease (PAD). Which of the following findings should the nurse expect?
- A. Warm extremities.
- B. Darkened skin color near extremities.
- C. Intermittent claudication.
- D. Edema.
Correct Answer: C
Rationale: Intermittent claudication, pain or cramping in the legs during exercise that subsides with rest, is a hallmark symptom of PAD due to reduced blood flow.
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A nurse is assisting a client who is postoperative following a total hip arthroplasty into a supine position. Which of the following actions is appropriate to prevent hip dislocation?
- A. Place a sandbag to the lateral calf.
- B. Place a wedge pillow between the legs.
- C. Place a trochanter roll against the thigh.
- D. Place a footboard on the bed.
Correct Answer: B
Rationale: Placing a wedge pillow between the legs maintains hip abduction, preventing adduction and reducing the risk of dislocation after hip arthroplasty.
A nurse is reviewing the laboratory reports for a client who has chronic kidney disease. Which of the following laboratory reports should the nurse expect to find?
- A. BUN 45 mg/dL, serum creatinine 1.0 mg/dL.
- B. BUN 11 mg/dL, serum creatinine 10 mg/dL.
- C. BUN 35 mg/dL, serum creatinine 8 mg/dL.
- D. BUN 10 mg/dL, serum creatinine 0.3 mg/dL.
Correct Answer: C
Rationale: Elevated BUN (35 mg/dL) and serum creatinine (8 mg/dL) are consistent with impaired kidney function in chronic kidney disease.
A nurse is collecting data from a client who has right-sided heart failure. Which of the following findings should the nurse expect?
- A. Frothy sputum.
- B. Orthopnea.
- C. Dyspnea.
- D. Peripheral edema.
Correct Answer: D
Rationale: Peripheral edema is a common finding in right-sided heart failure due to blood backup in systemic circulation, causing fluid accumulation in tissues.
A nurse is collecting data from a client who has end-stage kidney disease and is waiting for transport to dialysis. Which of the following findings should the nurse expect?
- A. Diaphoresis.
- B. Hypotension.
- C. Peripheral edema.
- D. Facial flushing.
Correct Answer: C
Rationale: Peripheral edema is common in end-stage kidney disease due to the kidneys' inability to remove excess fluid.
A nurse is contributing to the plan of care for a client who has urolithiasis. Which of the following interventions should the nurse include in the plan?
- A. Tell the client to expect a decrease in urine output.
- B. Provide the client a high protein diet.
- C. Maintain the client on bed rest.
- D. Encourage the client to drink 3 L of fluids per day.
Correct Answer: D
Rationale: Encouraging the client to drink 3 L of fluids per day helps flush out stones, prevent new stone formation, and reduce urinary concentration.