Nokea
The nurse is teaching the client diagnosed with arterial occlusive disease. Which interventions should the nurse include in the teaching? Select all that apply.
- A. Wash legs and feet daily in warm water.
- B. Apply moisturizing cream to feet.
- C. Buy shoes in the morning hours only.
- D. Do not wear any type of knee stocking.
- E. Wear clean white cotton socks.
Correct Answer: A,B,D,E
Rationale: Washing feet (A), moisturizing (B), avoiding knee stockings (D), and cotton socks (E) prevent skin breakdown and promote circulation in PAD. Morning shoe buying (C) is incorrect; shoes should be bought in the afternoon when feet are larger.
You may also like to solve these questions
The nurse and an unlicensed assistive personnel (UAP) are caring for a 64-year-old client who is four (4) hours postoperative bilateral femoral-popliteal bypass surgery. Which nursing task should be delegated to the UAP?
- A. Monitor the continuous passive motion machine.
- B. Assist the client to the bedside commode.
- C. Feed the client the evening meal.
- D. Elevate the foot of the client's bed.
Correct Answer: C
Rationale: Feeding the client (C) is within the UAP’s scope and safe post-bypass. Monitoring CPM (A), assisting to commode (B), and elevating bed (D) require nursing judgment due to circulation concerns.
The client diagnosed with arterial occlusive disease is one (1) day postoperative right femoral-popliteal bypass. Which intervention should the nurse implement?
- A. Keep the right leg in the dependent position.
- B. Apply sequential compression devices to lower extremities.
- C. Monitor the client's pedal pulses every shift.
- D. Assess the client's leg dressing every four (4) hours.
Correct Answer: C
Rationale: Monitoring pedal pulses (C) assesses graft patency post-bypass, critical to ensure circulation. Dependent position (A) impairs flow, compression devices (B) are for venous issues, and dressing checks (D) are routine but secondary.
The nurse is teaching the client with peripheral vascular disease. Which interventions should the nurse discuss with the client? Select all that apply.
- A. Wash your feet in antimicrobial soap.
- B. Wear comfortable, well-fitting shoes.
- C. Cut your toenails in an arch.
- D. Keep the area between the toes dry.
- E. Use a heating pad when feet are cold.
Correct Answer: B,D
Rationale: Well-fitting shoes (B) prevent injury, and dry toes (D) prevent infection in PVD. Antimicrobial soap (A) is unnecessary, arched toenails (C) risk ingrown nails, and heating pads (E) risk burns.
Which assessment data would cause the nurse to suspect the client has atherosclerosis?
- A. Change in bowel movements.
- B. Complaints of a headache.
- C. Intermittent claudication.
- D. Venous stasis ulcers.
Correct Answer: C
Rationale: Intermittent claudication (C) indicates arterial insufficiency from atherosclerosis. Bowel changes (A) and headaches (B) are nonspecific, and venous ulcers (D) are venous-related.
Which activity should the nurse advise a client with cardiomyopathy to avoid?
- A. Walking at a moderate pace
- B. Heavy weightlifting
- C. Swimming for 20 minutes
- D. Yoga with gentle stretches
Correct Answer: B
Rationale: Heavy weightlifting increases cardiac strain, which is dangerous in cardiomyopathy.