You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination?

Correct Answer: A

Rationale: Rationale for correct answer (A): - Size: Helps assess for muscle wasting or swelling. - Symmetry: Indicates potential arterial occlusion or venous insufficiency. - Skin color: Changes may suggest poor perfusion or venous stasis. Summary of incorrect choices: - B: Muscle bulk and tone are important but secondary to circulation assessment. - C: Nodules in joints are more relevant to rheumatologic conditions. - D: Lower extremity strength is important but not as critical for vascular assessment.

Correct Answer: C

Rationale: The correct answer is C: Time of onset of current stroke. This is the priority nursing assessment because the effectiveness of t-PA administration is time-dependent, with a narrow window of 4.5 hours from symptom onset. Knowing the time of onset will help determine if the client is within the appropriate timeframe for t-PA administration, which can improve outcomes. A: Current medications - While important, knowing the time of onset is more critical for timely intervention in ischemic stroke. B: Complete physical and history - Important for overall assessment but not as time-sensitive as determining the stroke onset time. D: Upcoming surgical procedures - Not relevant for immediate management of ischemic stroke with t-PA.

Correct Answer: B

Rationale: The correct answer is B: Pinching the skin over the sternum. Skin turgor is the skin's ability to return to its normal position after being pinched or pulled. The sternum is a central, flat bone that is less affected by factors like age or body fat distribution compared to other areas like the hands or abdomen. Pinching the skin over the sternum provides a more accurate assessment of skin turgor. Pinching the skin over the dorsum of the hand (A) may not be as reliable due to variations in skin thickness and elasticity. Pinching the skin over the forehead (C) and abdomen (D) are not ideal locations for assessing skin turgor as they are not commonly used for this purpose in clinical practice.

Correct Answer: A

Rationale: The correct answer is A: coulomb. Phase charge, which is the amount of electrical charge delivered during each phase of the waveform, is measured in coulombs. Coulomb is the standard unit of electric charge in the International System of Units (SI). It represents the quantity of electricity transported in one second by a current of one ampere. Ampere (B) is the unit of electric current, ohm (C) is the unit of resistance, and second (D) is the unit of time. Therefore, coulomb is the appropriate unit for measuring phase charge in a monophasic waveform.

Correct Answer: A

Rationale: The correct answer is A: C4. This is because the patient is able to direct their own care, which indicates intact cognitive function, a characteristic of C4 spinal cord injury level. The patient being dependent on others for all activities of daily living suggests a high level of physical impairment, aligning with the functional limitations associated with C4 injury. Choices B, C, and D are incorrect as they represent higher spinal cord injury levels with varying degrees of upper extremity function and independence in self-care activities.