Patho Patho #26

Question

The nurse is assessing a client with arterial insufficiency. Which finding does the nurse anticipate?

Answers

  1. A brownish discoloration of the affected foot
    • Rationale:

      This answer choice is not correct because a brownish discoloration of the foot is an indicator of venous insufficiency as opposed to arterial insufficiency.

  2. Central cyanosis
    • Rationale:

      This answer choice is not correct because central cyanosis is an indication of systemic hypoxemia and not expected with chronic arterial insufficiency.

  3. Crackles in the lower lung lobes
    • Rationale:

      This answer choice is not correct as crackles in the lower lung lobes are indicative of fluid volume overload that may be attributed to a number of possible causes and is not associated with arterial insufficiency.

  4. A foot that turns pale when elevated
    • Rationale:

      This answer is correct because a foot that turns pale when elevated is a classic manifestation of arterial insufficiency. The distal extremities are not well perfused when arterial insufficiency is present which leads to the paleness when the extremity is elevated.

Overview

The focus of this question is asking the nurse to identify an expected finding associated with arterial insufficiency. When arterial insufficiency is present, then extremities are not adequately perfused. When the lower extremity is elevated, it will turn pale due to lack of arterial perfusion in clients with arterial insufficiency.

Explanation

Learning Outcomes

Arterial insufficiency is a form of peripheral vascular disease. It develops over time as plaque builds up within arterial walls causing narrowing within the arterial walls. Peripheral perfusion is eventually affected due to narrowing of the arterial lumen which leads to a pale foot when elevated. Additional symptoms of arterial insufficiency include lack of hair growth in the area of deceased perfusion, weak, thready pulses, and possibly ulcerations.

Test Taking Tip

Peripheral vascular disease is an umbrella term used to describe chronic venous insufficiency and arterial insufficiency which have very different manifestations.

Video Rationale