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MED SURG HESI VERSION 1.
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MED SURG HESI VERSION 1. 1. The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit. The client, who exercises regularly, reports having pain in the calf during exercise that disappears at rest. Which of the following findings requires further evaluat...

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  • February 6, 2023
  • 86
  • 2022/2023
  • Exam (elaborations)
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  • who exercises regularly
  • med surg hesi version 1 1 the nurse is assessing a 48 year old client with a history of smoking during a routine clinic visit the client
  • reports having pain in the calf d

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  • MED SURG HESI
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MED SURG HESI VERSION 1.

1. The nurse is assessing a 48-year-old client with a history of smoking
during a routine clinic visit. The client, who exercises regularly, reports
having pain in the calf
during exercise that disappears at rest. Which of the following findings requires further
evaluation?
1. Heart rate 57 bpm.
2. SpO2 of 94% on room air.
3. Blood pressure 134/82.
4. Ankle-brachial index of 0.65.
An Ankle-Brachial Index of 0.65 suggests moderate arterial vascular disease in a client who
is experiencing intermittent claudication. Normal ABI 1-1.4. A Doppler ultrasound is
indicated for further evaluation. The bradycardic heart rate is acceptable in an athletic
client with a normal blood pressure. The SpO2 is acceptable; the client has a smoking
history.




2. A client with peripheral vascular disease has undergone a right
femoral popliteal bypass graft. The blood pressure has decreased from
124/80 to 94/62. What should the nurse assess first?
1. IV fluid
solution. 2.
Pedal pulses.
3. Nasal cannula flow rate.
4. Capillary refill.
With each set of vital signs, the nurse should assess the dorsalis pedis
and posterior tibial pulses. The nurse needs to ensure adequate
perfusion to the lower
extremity with the drop in blood pressure. IV fluids, nasal cannula setting,
and capillary refill are important to assess; however, priority is to determine
the cause of drop in blood pressure and that adequate perfusion through
the new graft is maintained.
CN: Reduction of risk potential; CL: Analyze

,3. An overweight client taking warfarin (Coumadin) has dry skin due to decreased

,arterial blood flow. What should the nurse instruct the client to do? Select all
that apply. 1. Apply lanolin or petroleum jelly to intact skin.
2. Follow a reduced-calorie, reduced-fat diet.- promote circulation by
reducing weight. 3. Inspect the involved areas daily for new ulcerations.
4. Instruct the client to limit activities of daily living
(ADLs). 5. Use an electric razor to shave.
1, 2, 3, 5. Maintaining skin integrity is important in preventing chronic ulcers
and infections. The client should be taught to inspect the skin on a daily
basis. The client should reduce weight to promote circulation; a diet lower in
calories and fat is appropriate. Because the client is receiving Coumadin,
the client is at risk for bleeding from cuts. To decrease the risk of cuts, the
nurse should suggest that the client use an electric razor. The client with
decreased arterial blood flow should be encouraged to participate in ADLs.
In fact, the client should be encouraged to consult an exercise physiologist
for an exercise program that enhances the aerobic capacity of the body. CN:
Health promotion and maintenance; CL: Synthesize




4. The nurse is caring for a client with peripheral artery disease who has
recently been prescribed clopidogrel (Plavix). The nurse understands
that more teaching is necessary when the client states which of the
following:
1. “I should not be surprised if I bruise easier or if my gums bleed a
little when brushing my teeth.”
2. “It doesn't really matter if I take this medicine with or without
food, whatever works best for my stomach.”
3. “I should stop taking Plavix if it makes me feel weak and dizzy.”
4. “The doctor prescribed this medicine to make my platelets less
likely to stick together and help prevent clots from forming.”
Weakness, dizziness, and headache are common adverse effects of
Plavix and the client should report these to the physician if they are
problematic; in order to decrease risk of clot formation, Plavix must
be taken regularly and should not be
stopped or taken intermittently. The main adverse effect of Plavix is
bleeding, which often occurs as increased bruising or bleeding when brushing
teeth. Plavix is well absorbed, and while food may help decrease potential
gastrointestinal upset, Plavix may be taken with or without food. Plavix is an
antiplatelet agent used to prevent clot formation in clients who have
experienced or are at risk for myocardial infarction, ischemic stroke,
peripheral artery disease, or acute coronary syndrome.

, CN: Pharmacological and parenteral therapies; CL: Evaluate

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