EVOLVE
1. The student nurse is reviewing the patient’s chart and notes that the patient experiences intermittent claudication. When is the patient
... [Show More] most likely to experience this disorder?
• After exercise
Intermittent claudication is inadequate arterial supply to muscles in the lower extremities that results in severe cramping of the muscles after activity.
Dorsiflexion of the foot when phlebitis is present is a positive Homan sign, indicating the possible presence of deep vein thrombosis (DVT). However, it is no longer considered a reliable assessment for DVT.
• Immediately after exposure to cold
• First thing in the morning after getting out of bed
• After dorsiflexion of the foot when phlebitis is present
2. Which of these complaints, if made by a 58-year-old man, may reflect a symptom of hypertension?
• “My vision is a little blurry.”
Patients often have no signs or symptoms until the later stages of hypertension. Signs and symptoms that patients may experience include headache, dizziness, blurred vision, blackouts, irritability, angina, dyspnea, or fatigue. Hearing problems, back pain, and sleep disturbances are not associated with hypertension.
• “I’m having some hearing problems.”
• “My back seems to be hurting me more frequently.”
• “I’m not sleeping as late in the morning as I used to.”
3. A patient complains of burning and numbness in her hands and states that “they turn really red” if she is in an air-conditioned environment for too long. The nurse would anticipate which diagnosis?
• Hypertension
• Arterial occlusion
• Raynaud disease
Symptoms of Raynaud disease result from intermittent ischemia occurring from exposure to cold. The symptoms generally resolve when the extremities are warmed. Symptoms of CTS (nerve compression in the upper extremity) are not generally temperature related. Arterial occlusion would result in blanching of the affected extremity, not reddening. These are not typical symptoms of hypertension.
• Carpal tunnel syndrome (CTS)
4. A patient has been diagnosed with mild hypertension. Which intervention(s) will likely be included in his plan of care?
• Controlling his weight
• Restricting sodium intake in his diet
• Taking an adrenergic-inhibiting drug
• Incorporating exercise into his daily routine
• Developing methods to help with controlling stress
Treatment for hypertension is usually a stepped care approach. The typical interventions for a patient diagnosed with mild hypertension include smoking cessation, weight reduction, sodium restriction, alcohol restriction, exercise, a low-fat diet, and stress control. Medications are usually added if these lifestyle changes do not control the blood pressure.
5. A 46-year-old patient has been diagnosed with hypertension. His resting blood pressure (BP) is 180/100 mm Hg. His physician has ordered an electrocardiogram, chest x-ray, urinalysis, and renal function studies. He asks the nurse, “Why are all these tests necessary?” Which is the best response by the nurse?
• “You might have had a heart attack.”
• “These tests are always part of a work-up.”
• “These tests can determine changes in your kidneys that can cause hypertension.”
Many patients do not realize that the renal system directly affects the BP. Altered renal function can lead to hypertension. The nurse would be incorrect in stating the patient may have had a heart attack, that these tests are always part of a work-up, and that a urinary tract infection would be the cause of this patient’s hypertension.
• “If you have a urinary tract infection, we will know what caused your hypertension.”
6. The nurse is caring for a patient recently diagnosed with peripheral arterial disease. Which activities should the nurse educate the patient to avoid?
• Walking
• Swimming
• Elevating the legs
• Constrictive clothing
• Cold room temperature
Cold room temperature will discourage blood flow. Elevating the legs puts pressure on the back of the knees and further occludes blood flow.
Constrictive clothing could disrupt blood flow. Walking regularly encourages
blood flow. Swimming applies light pressure to the surface of the legs and encourages venous return.
7. The patient has recently been diagnosed with varicose veins and states, “I really don’t understand what varicose veins are.” Which response by the nurse most accurately describes varicose veins?
• “Varicose veins are veins that are enlarged and engorged with blood.”
Varicose veins are enlarged, tortuous veins engorged with pooled blood. Veins that develop varicosities have incompetent valves that allow reflux of blood from the deep to the superficial veins. Varicose veins are not atrophied, sclerotic, stenotic, or [Show Less]