Chapter 53: Management of Clients with Vascular Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 53: Management of Clients with Vascular Disorders

MULTIPLE CHOICE

1. The nurse teaches the client with intermittent claudication that the pain results from

a.

lactic and pyruvic acid buildup.

b.

muscle cramps.

c.

rapid vasodilation in the legs.

d.

venous stasis.

ANS: A

Waste produced by lactic and pyruvic acid builds up quickly in oxygen-deprived muscles.

DIF: Comprehension/Understanding REF: p. 1307 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. The nurse is caring for a client who is taking warfarin sodium (Coumadin) for a history of DVT. Before administering the medication, the nurse should assess the clients

a.

Homans sign.

b.

PT, INR.

c.

PTT.

d.

vital signs.

ANS: B

The PT and INR are used to monitor therapy with warfarin. The PTT is used to guide heparin therapy. The Homans sign is not considered a very reliable assessment for DVT. The nurse administering either warfarin or heparin should know the results of the latest monitoring test before giving the client the drug in order to prevent possible complications if the level is too high.

DIF: Application/Applying REF: p. 1335 OBJ: Assessment

MSC: Safe, Effective Care Environment Safety and Infection Control-Error Prevention

3. The nurse would inform a client diagnosed with a 2-cm aneurysm that such aneurysms usually require

a.

a resection.

b.

grafting.

c.

medications to raise BP.

d.

semi-annual ultrasound.

ANS: D

Aneurysms less the 4 cm are usually not surgically repaired, but instead are assessed twice a year by ultrasound to assess changes. Antihypertensive medications are prescribed if indicated.

DIF: Comprehension/Understanding REF: p. 1326 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

4. When teaching foot care to a client with chronic arterial occlusive disease, the nurse would tell the client to avoid

a.

using cornstarch on the feet.

b.

using toenail clippers.

c.

wearing canvas shoes.

d.

wearing cotton socks.

ANS: C

Instructions for clients with chronic arterial occlusive disease include (a) dust feet lightly with cornstarch if they sweat; (b) use clippers, not scissors, to cut toenails; (c) wear cotton socks for absorbency; and (d) avoid shoes that cause feet to perspire (e.g., canvas shoes, rubber boots).

DIF: Application/Applying REF: p. 1313 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

5. In the exercise teaching plan for a client with chronic arterial occlusive disease, the nurse would caution the client to

a.

avoid exercising the feet in the dependent position.

b.

elevate feet periodically for 30 minutes.

c.

not walk if an open ulcer forms.

d.

walk a little farther each day even if pain occurs.

ANS: C

Although exercise helps most clients with vascular disorders, some clients must not exercise, such as those with leg ulcers, pain at rest, cellulitis, deep vein thrombosis, or gangrene.

DIF: Application/Applying REF: p. 1314 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

6. A client is scheduled to have a femoral-popliteal bypass with a synthetic graft. The nurses preoperative teaching would include information about preoperative

a.

antibiotics.

b.

anticoagulants.

c.

platelets.

d.

skin preparation.

ANS: A

Broad-spectrum antibiotics normally are prescribed for bypass clients preoperatively. Other common preoperative measures include administration of IV fluids, inserting a urinary catheter, and weighing the client.

DIF: Comprehension/Understanding REF: p. 1316 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

7. A client is scheduled for a guillotine amputation and is crying, stating that he/she cannot live with such an ugly leg. The information from the nurse that would best help the client cope with the upcoming surgery is to tell the client that

a.

in another operation, the stump edge will be covered with a skin flap.

b.

it is either have the amputation or die from the infection.

c.

later cosmetic surgery is an option if the amputation cures the infection.

d.

while wearing a prosthesis, no one will be able to see the ugly leg.

ANS: A

The major indication for guillotine amputation is infection. The surgeon does not close the stump with a skin flap immediately but leaves it open, allowing the wound to drain freely. Antibiotics are used. Once the infection is completely eradicated, the client undergoes another surgery for stump closure.

DIF: Application/Applying REF: p. 1317 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

8. .Before a clients amputation, the nurse would counsel that the client may experience phantom sensation after surgery, which is

a.

the sensation that the leg is still there.

b.

experiencing painful feelings in the amputated leg.

c.

neuropathy that may delay prosthesis fitting.

d.

part of establishing a new center of gravity.

ANS: A

Phantom sensations are caused by intact peripheral nerves proximal to the amputation site that carried messages between the brain and the now amputated part. These sensations are normal, and the client should be prepared for them. Phantom sensations often are felt immediately after surgery and gradually decrease over the next 2 years. Phantom pain is the sensation of pain from the same nerves.

DIF: Comprehension/Understanding REF: p. 1320 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. For the first 24 hours after a clients leg amputation, the nurse would place the stump

a.

Below the level of the heart.

b.

elevated on a pillow.

c.

flat on the bed.

d.

in external rotation.

ANS: B

Edema is controlled by elevating the stump for the first 24 hours after surgery. After this time, the stump is placed flat to avoid hip contracture. Placing the stump below the level of the heart would impede venous flow and would increase edema. Placing the stump in external rotation would not help with edema control either.

DIF: Application/Applying REF: p. 1321 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

10. To prevent skin breakdown of a clients stump, the nurse teaches the client to

a.

adjust the prosthesis if it causes discomfort.

b.

apply alcohol to the stump to toughen the skin.

c.

wash the stump daily with mild soap, and then rinse and dry it.

d.

wear cotton stump socks.

ANS: C

The nurse should wash the stump with a mild soap, then carefully rinse and dry it. Nothing is applied to the stump after it is bathed. Alcohol dries and cracks the skin. Woolen stump socks should be used. The prosthesis should be adjusted professionally if it causes discomfort.

DIF: Application/Applying REF: p. 1323 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

11. The nurse would explain to a client that anticoagulant therapy is used in the treatment of thromboembolic disease because anticoagulants can

a.

decrease blood viscosity.

b.

dissolve the thrombi.

c.

inhibit the synthesis of clotting factors.

d.

prevent absorption of vitamin K.

ANS: C

Anticoagulant therapy is based on the premise that the initiation or extension of thrombi can be prevented by inhibiting the synthesis of clotting factors or by accelerating their inactivation. The anticoagulants heparin and warfarin do not induce thrombolysis but effectively prevent clot extension.

DIF: Comprehension REF: pp. 1333, 1334

OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

12. For a client with deep vein thrombosis (DVT), the nurse would include in the plan of nursing care the intervention of

a.

applying cool compresses to the area.

b.

maintaining the legs in the dependent position.

c.

raising the foot of the bed 6 inches.

d.

restricting fluids.

ANS: C

Elevation of the legs decreases venous pressure, which in turn relieves edema and pain in the client with DVT. Warm compresses can be comforting. Restricting fluids is not in the plan of care.

DIF: Application/Applying REF: pp. 1334-1335

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

13. When a client complains of heaviness, aching, and itching of both legs for the past year, the nurse recognizes these complaints as being most suggestive of

a.

Buergers disease.

b.

deep vein thrombosis.

c.

Raynauds phenomenon.

d.

varicose veins.

ANS: D

Clients with varicose veins complain of aching, a feeling of heaviness, itching, moderate swelling, and the often unsightly appearance of their legs.

DIF: Comprehension/Understanding REF: p. 1335 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

14. An appropriate nursing diagnosis to guide self-care teaching for a client who has lymphedema is

a.

Impaired Adjustment.

b.

Risk for Disuse Syndrome.

c.

Risk for Fluid Volume Excess.

d.

Risk for Infection.

ANS: D

The client with lymphedema is at high risk for infection.

DIF: Knowledge/Remembering REF: pp. 1338, 1339

OBJ: Diagnosis

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

15. A client is scheduled for computed tomography (CT) of the abdomen because of a suspected abdominal aortic aneurysm. The nurse would assess this client for

a.

abdominal pain radiating down one or both legs.

b.

abdominal rebound tenderness.

c.

painful abdominal distention.

d.

pulsating abdominal mass.

ANS: D

The most common clinical manifestation is awareness of a pulsating mass in the abdomen, with or without pain, followed by abdominal pain and back pain.

DIF: Knowledge/Remembering REF: p. 1326 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

16. For a client admitted with a history of chronic arterial insufficiency, the nurse would anticipate that physical assessment will reveal

a.

rubor with elevation of feet.

b.

pallor when feet are dependent.

c.

diminished pedal pulses.

d.

warm, edematous skin.

ANS: C

Objective data associated with arterial insufficiency include weak or absent peripheral pulses, dependent rubor, pallor with elevation, hypertrophied toenails, tissue atrophy, ulceration, and gangrene.

DIF: Comprehension/Understanding REF: p. 1308 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

17. A female client with Raynauds disease asks the nurse why she is taking the same calcium channel blocker that her brother-in-law takes for a heart condition. The nurses response would include information that the calcium channel blocker will relieve some clinical manifestations of Raynauds disease by

a.

decreasing vasospasm.

b.

increasing cardiac output to increase circulation.

c.

increasing vasodilation.

d.

reducing the pain in the extremities.

ANS: A

Calcium antagonists, such as nifedipine and verapamil, are the drugs of choice because they can decrease the frequency, duration, and intensity of vasospastic attacks.

DIF: Comprehension/Understanding REF: pp. 1330-1331

OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

18. A client is wearing sequential compression devices (SCDs) on the bilateral lower legs. Nursing care for these devices includes

a.

not allowing the client to ambulate.

b.

pre-wrapping the legs with Ace bandages.

c.

removing them twice a day to inspect skin.

d.

turning them off every 2 hours for 10 minutes.

ANS: C

SCDs are used to prevent DVTs in high-risk clients. They need to be removed twice a day to allow perspiration to dry, for bathing, and to inspect the skin. The devices do not prevent a client from ambulating, although they need to be removed first. Many clients with SCDs will be on bed rest, however. There is no need to pre-wrap the legs or to turn the machine on and off.

DIF: Application/Applying REF: p. 1334 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

19. The nurse explains to a client started on daily doses of Plavix after femoral bypass surgery that the purpose of this regimen is to

a.

decrease platelet aggregation.

b.

decrease postoperative pain.

c.

increase vasodilation in the legs.

d.

prevent postoperative fever.

ANS: A

Medications that decrease platelet aggregation, such as aspirin and clopidogrel (Plavix), are used to increase the length of graft patency.

DIF: Comprehension/Understanding REF: p. 1316 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

20. Immediately after a clients revascularization surgery, the nurse would position the client with the

a.

feet elevated on pillows.

b.

legs flexed with the knee gatch up.

c.

legs separated with pillows.

d.

operative leg totally flat.

ANS: D

The operated leg should be kept straight to prevent occlusion of the vessels. Options a and b would increase the risk of vessel occlusion. The legs do not need to be separated with pillows.

DIF: Application/Applying REF: p. 1316 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

21. A client is recovering from a leg amputation and is doing well. However, the nurse still cautions the client to

a.

avoid any trips with the new prosthesis in the next year or so.

b.

call for help when getting out of bed.

c.

limit pain medication to prevent dizziness at therapy.

d.

not be too excited about progress until fitted with the prosthesis.

ANS: B

A client with an amputation has to learn to adapt to a new center of gravity, making transfers and ambulation potentially difficult. Until the client has completely adapted, he/she will need assistance with ambulation and transfers, even if just going from bed to chair, to prevent injury. Clients may even need assistance turning in bed until they adapt.

DIF: Application/Applying REF: p. 1323 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

22. A client is scheduled for a below-the-knee amputation for treatment of chronic infected arterial ulcers and leg pain. The client seems calm, and even happy. The nurse should respond to this client based on understanding that the client

a.

cannot cope effectively with a life-altering procedure.

b.

is experiencing dysfunctional grieving for the leg.

c.

may prefer an amputation to living with chronic pain.

d.

might have cognitive defects preventing full understanding.

ANS: C

Assessment of the clients attitude towards amputation is a vital preoperative assessment. While all options are certainly possible, some clients who suffer from chronic ischemia might prefer an amputation to living with pain and disability. This is an important quality of life value and should be assessed in order to plan holistic postoperative care.

DIF: Application/Applying REF: pp. 1317-1320

OBJ: Assessment MSC: Psychosocial Integrity Psychosocial Adaptation-Quality of Life

23. The nurse working in the emergency department (ED) receives a telephone call from an individual who states a co-workers finger was amputated and asks what should be done. The nurse would tell the caller to immediately

a.

pack the finger immediately in a plastic bag filled with ice.

b.

place the finger in a bowl full of cool water or normal saline, if available.

c.

wash and rinse the finger and wrap it in a clean, warm towel.

d.

wrap the finger in a clean cloth and place it in a plastic bag, then on ice.

ANS: D

The limb should be wrapped in a cloth and placed in a plastic bag and then on ice. The limb or digit should not come in contact with ice or water to prevent direct tissue damage.

DIF: Application/Applying REF: pp. 1323-1324

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

24. When a client who has been taking warfarin (Coumadin) for 2 years tells the nurse of plans for oral surgery, the nurse would caution the client to

a.

avoid taking aspirin for postoperative pain.

b.

contact the physician to arrange vitamin K injections before surgery.

c.

obtain an International Normalized Ratio (INR) 1 day before surgery.

d.

stop taking Coumadin for 3 or 4 days before surgery.

ANS: D

Warfarin has a long half-life of 3 to 4 days. Before surgery the client should cease taking Coumadin for that period.

DIF: Analysis/Analyzing REF: p. 1334 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

25. The nurse reading the admission note for a client who has an arterial leg ulcer would anticipate that the ulcer will be characterized

a.

as being surrounded by atrophic tissue.

b.

as producing minimal pain.

c.

by a deep-red base.

d.

by irregular borders.

ANS: A

Arterial leg ulcers are very painful, which distinguishes them from venous stasis ulcers. Arterial ulcers also have a sharp edge and a pale base and often are surrounded by atrophic tissue.

DIF: Application/Applying REF: p. 1325 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

26. A client scheduled for a repair of an abdominal aortic aneurysm reports increased abdominal pain accompanied by new onset of intense back and flank pain. The priority action by the nurse would be to

a.

administer a prescribed analgesic.

b.

notify the physician immediately.

c.

reassess the client in another 5 minutes.

d.

take another set of vital signs.

ANS: B

Ruptured abdominal aortic aneurysm presents with a triad of manifestations, including abdominal pain combined with intense back and flank pain and possible scrotal pain, a pulsating abdominal mass or a rigid abdomen from the hemorrhage, and shock. Surgery is the only intervention for clients with a ruptured abdominal aortic aneurysm.

DIF: Application/Applying REF: pp. 1328-1329

OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

27. A client is scheduled for discharge to home after repair of an abdominal aortic aneurysm. As an acceptable activity during the first 6 to 12 weeks after surgery, the nurse would suggest

a.

mowing the lawn.

b.

vacuuming the floor.

c.

walking.

d.

washing windows.

ANS: C

Activities that involve lifting heavy objects, usually more than 15 to 20 pounds, are not permitted for 6 to 12 weeks postoperatively. Activities that involve pushing, pulling, or straining may also be restricted. Driving may be restricted because of postoperative weakness and decreased response time. Walking is acceptable. Clients can resume sexual activity within 4-6 weeks; however, the risk of impotence should be discussed preoperatively with male clients.

DIF: Comprehension/Understanding REF: p. 1328 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

28. A client who is overweight and smokes is newly diagnosed with thromboangiitis obliterans. The nurses teaching plan would focus on the highest priority of

a.

controlling high blood pressure.

b.

exercising regularly.

c.

following a low-fat diet.

d.

smoking cessation.

ANS: D

The need for smoking cessation must be clearly and unequivocally conveyed to the client and family.

DIF: Application/Applying REF: p. 1331 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

29. The nurse caring for a client with a traumatic arm amputation knows that care will be significantly different from other clients with amputations because

a.

clients with traumatic amputations are usually young and get well fast.

b.

the postoperative complication rate is lower than with venous insufficiency.

c.

the surgery to repair the limb is not as involved as with arterial insufficiency.

d.

there was no time beforehand to grieve the loss of the limb.

ANS: D

In a planned amputation, the client has some time before the operation to grieve the upcoming loss of limb and to begin to incorporate this into a new self-identity. With traumatic amputations, the client has no warning and no time to grieve or to adjust beforehand.

DIF: Comprehension/Understanding REF: pp. 1323-1324

OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Unexpected Body Image Changes

30. When a client scheduled for insertion of a vena cava filter begins to sweat and becomes diaphoretic, the nurse would recognize these clinical manifestations as

a.

cerebrovascular accident.

b.

myocardial infarction.

c.

onset of pneumonitis.

d.

pulmonary embolism.

ANS: D

These are cardinal manifestations of a pulmonary embolism, which requires immediate intervention.

DIF: Analysis/Analyzing REF: p. 1335 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

31. In teaching the preoperative ambulatory surgery client scheduled for vein ligation and stripping, the nurse would include that immediately after surgery, the client will

a.

experience pain and swelling in the leg.

b.

have legs wrapped with Ace bandages from heel to groin.

c.

have the head of the bed put on blocks to elevate it 6 to 9 inches.

d.

need to sit in a comfortable chair with legs dependent.

ANS: B

Elastic compression bandages are applied from foot to groin. The legs should not be dependent. There will be some pain, which can be managed.

DIF: Comprehension/Understanding REF: p. 1336 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

32. The nurse would inform a client with a venous ulcer that the clients ulcer will be treated with the traditional protocol of

a.

daily warm soaks and application of wet-to-moist saline dressings.

b.

enzymatic debridement and the area left open to air.

c.

local antibiotic ointment applied twice a day.

d.

pressure dressing left in place for 5 to 7 days.

ANS: D

No topical treatment for venous ulcer is adequate without a compression dressing capable of sustaining pressure for at least 1 week.

DIF: Application/Applying REF: p. 1338 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

33. For a hospitalized client who experienced a sudden arterial occlusion yesterday, the nurse would review the chart for a history of

a.

atrial fibrillation.

b.

hypertension.

c.

iron deficiency anemia.

d.

oral contraceptive use.

ANS: A

Emboli, the most common cause of sudden ischemia, usually are of cardiac origin during periods of atrial fibrillation.

DIF: Comprehension/Understanding REF: p. 1324 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

34. When a client with arterial insufficiency complains of being awakened at night by pain in the legs, the nurse would recommend that the client sleep

a.

after exercising for 10 to 15 minutes.

b.

in a recliner with feet dependent.

c.

propped up by several pillows.

d.

with legs covered by an extra blanket.

ANS: B

Placing the legs in a dependent position provides increased gravitational blood supply.

DIF: Application/Applying REF: p. 1308 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

35. A clients blood pressure is mm Hg in the brachial artery and mm Hg in the tibialis artery. After computing the A/B index, the nurse would record that the clients index indicates

a.

a normal ratio.

b.

mild ischemia.

c.

moderate ischemia.

d.

severe ischemia.

ANS: A

The ankle systolic pressure (A) is divided by the brachial pressure (B): . The normal A/B value is more than 1; the value is 0.5 in severe disease.

DIF: Comprehension/Understanding REF: pp. 1309-1310, 1324

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

MULTIPLE RESPONSE

1. Important health promotion measures a nurse could teach a client in order to avoid another episode of DVT include (Select all that apply)

a.

avoiding prolonged sitting.

b.

elevating the legs when sitting.

c.

maintaining an ideal body weight.

d.

remaining hydrated.

ANS: A, C, D

Virchows triad describes the pathophysiologic conditions that have to exist in order to have a DVT. The components are venous stasis (caused by immobilization, prolonged travel, pregnancy, lack of use of the calf muscle pump, and heart disease, among others), hypercoagulability (caused by dehydration, blood dyscrasias, and oral contraceptives, among other things), and vascular injury (caused by fractures, trauma, dislocations, and chemical irritation, among other things). Two of the three factors must be present to form a DVT.

DIF: Application/Applying REF: pp. 1331-1332

OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

2. A client who is receiving IV heparin has a PTT reported by the lab as 101. Appropriate actions by the nurse include (Select all that apply)

a.

continuing to monitor the heparin infusion.

b.

instituting safety precautions.

c.

notifying the physician.

d.

ordering another PTT in the morning.

e.

turning off the heparin IV.

ANS: B, C, E

Bleeding can occur in the client receiving anticoagulant therapy. Heparin infusions are monitored with the PTT. Therapeutic levels are generally greater than 60, but at 1.5-2.5 times the baseline (normal is around 25-35). A PTT of 101 is a critical result and the nurse should (1) stop the heparin infusion, (2) notify the physician, and (3) place the client on bleeding precautions. A small injury to the client can cause bleeding. The client can also have spontaneous bleeding. The nurse should observe the client for bleeding, as evidenced by frank hemorrhage, changes in mental status, pink-tinged or frank blood in the urine, dark or tarry stools, and bleeding after brushing the teeth.

DIF: Analysis/Analyzing REF: p. 1334 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

3. A nurse suspects a client has an acute arterial occlusion. Early assessment findings that would confirm her suspicion include (Select all that apply)

a.

pain.

b.

pallor.

c.

paralysis.

d.

paresthesias

e.

pulselessness.

ANS: A, B, E

Early signs are pain, pallor, and pulselessness. Paresthesias indicate advanced damage. Paralysis indicates irreversible damage.

DIF: Analysis/Analyzing REF: p. 1324 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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