rts (11)

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Rasmussen College *

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4150CCB

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Nursing

Date

Nov 24, 2024

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pdf

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3

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ANSWER: 3 Aneurysm rupture is a life-threatening occurrence and the highest risk for the client until it can berepaired. Hypotension, cardiac arrhythmias, and loss of bowel sounds are all significant potential complications; however, they are not life threatening. 7.A client who has experienced signs of Virchows triad has developed a deep vein thrombosis. Which of the following is not a part of this triad? 1.Venous stasis 2.Vessel wall injury 3.Alteration in blood clotting 4.Pregnancy ANSWER: 4 Pregnancy is a risk factor for thrombus, but it is not part of Virchows triad.Virchows triad includes venous stasis, vessel wall injury, and alteration of blood coagulation. 8.A client is diagnosed with Buergers disease. Which of the following should the nurse instruct the client regarding this disorder? 1. It is a common disorder. 2. It appears in women more than in men. 3.Smoking exacerbates the disease. 4.It is more common in African AmericAnswer. ANSWER: 3 Smoking cessation halts the disease progress, but continuation of smoking exacerbates the progression of the disease. Buergers disease is a rare disorder. It is more common in men than women. It is more common in AsiAnswer and rare among African AmericAnswer. 9.A client is diagnosed with Raynauds disease. Which of the following will the nurse most likely assess in this client? 1. Elevated blood pressure 2. Pain, cyanosis, and numb, cold extremities 3.Absent peripheral pulses 4.Increase in varicose veins
ANSWER: 2 Clinical manifestations of Raynauds disease include venospasms; pain; cyanosis; redness; numb, cold extremities; and swelling. Elevated blood pressure, absent peripheral pulses, and varicose veins are not associated with this disorder. 10.A client is diagnosed with acute peripheral arterial occlusion. The nurse should prepare to providewhich of the following interventions for this client? 1. Administer oxygen. 2. Assist with ambulation. 3. Administer heparin as prescribed. 4.Restrict fluids. ANSWER: 3 In the treatment of acute peripheral arterial occlusion, intravenous heparin therapy is usually the first intervention. Oxygen is not the first intervention for this client. The client will most likely be on bed rest and will not ambulate. Restricting fluids would not be indicated for acute peripheral arterial occlusion. 11.A client receiving a heparin infusion is demonstrating signs of acute bleeding. Which of the following should the nurse prepare to administer to this client? 1.Aspirin 2.Vitamin K 3.Protamine sulfate 4.Narcan ANSWER: 3 Protamine sulfate is the heparin antagonist used for excessive bleeding. Vitamin K is the antagonist for warfarin. Aspirin and narcan are not used for bleeding associated with a heparin infusion. 12.A clients blood pressure measurements have a 20 mmHg difference between the upper extremity readings. Which of the following does this assessment finding suggest to the nurse? 1.Arteriosclerosis 2.Aortic aneurysm
3.Deep vein thrombosis 4.Subclavian steal syndrome ANSWER: 4 A difference of greater than 20 mmHg when assessing bilateral blood pressure measurements is considered a significant finding in the diagnosis of subclavian steal syndrome. This blood pressure discrepancy is not a finding with arteriosclerosis, aortic aneurysm, or deep vein thrombosis. 13.The nurse is assessing a client for risks in the development of varicose veins. Which of the following findings would increase this clients risk? 1.Normal weight 2.Prolonged standing 3. Engages in golf three times a week 4. Eats several servings of fruits and vegetables each dayANSWER: 2 Risk factors for the development of varicose veins include thrombophlebitis, obesity, prolonged standing, pregnancy, and liver or pancreas dysfunction. Normal weight, activity, and balanced diet are not risk factors for the development of varicose veins. CH: 38. Common Abdominal Complaints Multiple Choice Identify the choice that best completes the statement or Answerwers the question. 1. A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical examination? a. Digital rectal exam b. Pelvic exam c. Sexual history d. All of the above 2. A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation? a. Multivitamin b. Magnesium hydroxide c. Pepto-Bismol®
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