04 The Client with Raynaud's Disease

[John]

The Client with Raynaud's Disease

55. Raynaud's disease is known as arteriospastic disease and is seen most often in

1. young women.

more common in young women

is associated with collagen diseases such as rheumatoid arthritis and lupus.

2. old women.

3. old men.

4. young men.

56. The nurse has been assigned to a client with Raynaud's disease.

The nurse realizes that the underlying etiology of Raynaud's disease is unknown but that it is characterized by

1. episodic vasospastic disorder of the small arteries.

vasospasms of the small cutaneous arteries involving the fingers and toes.

2. episodic vasospastic disorder of the small veins.

3. episodic vasospastic disorder of the capillaries.

4. episodic vasospastic disorder of the aorta.

 

57. The client with Raynaud's disease complains of cold and numbness in her fingers. The nurse assesses the client for effects of vasoconstriction.

Which of the following is an early sign of vasoconstriction?

1. Cyanosis.

2. Gangrene.

the end result of complete arterial occlusion.

The skin is blackened and without a blood supply.

3. Pallor.

Initially the vasoconstriction effect produces pallor or a whitish coloring,

followed by cyanosis (bluish) and finally rubor (red).

4. Rubor.



58. A female client has Raynaud's disease.

During the initial assessment, the nurse notes that the client is experiencing a vasospastic episode. The nurse will immediately assess the

1. brachial artery.

2. carotid artery.

3. femoral artery.

4. radial artery.

the small cutaneous arteries of the fingers and toes.

The nurse will be able to palpate the radial artery.

If the disease process affects the lower extremities,

the nurse will be able to palpate the dorsalis pedis artery

during a vasospastic episode.

59. The nurse should instruct a client who has been diagnosed with Raynaud's disease to

1. immerse her hands in cold water during an episode.

in warm water during an episode

to promote vasodilation and relaxation of the small arteries that are in spasm.

2. wear light garments when the temperature gets below 50°F (l0°C).

Extreme changes in temperature can precipitate a vasospastic episode

and should be avoided by clients with Raynaud's disease.

The client can help prevent vasospasm brought on by temperature changes

by wearing warm clothes.

3. wear gloves when handling ice or frozen foods.

4. live in a cold climate.

will exacerbate the symptoms



60. Stress can produce vasospasm in clients with Raynaud's disease.

The client states she is worried about making the necessary behavioral changes

to control the vasospastic episodes.

Which of the following nursing diagnoses is appropriate?

1. Activity Intolerance related to Raynaud's disease.

2. Anxiety related to change in health status.

The goal for the client

is to learn strategies for effective coping with anxiety- producing situations.

3. Disturbed Body Image related to illness treatment.

4. Impaired Social Interaction related to self-concept disturbance.

61. The physician has prescribed a beta-adrenergic blocking medication for the client with Raynaud's disease. An example of a beta-adrenergic blocker is

1. tamsulosin hydrochloride (Flomax).

blocks the smooth muscle a-adrenergic receptors in the prostate,

leading to relaxation of the prostate and bladder.

2. terazosin hydrochloride (Hytrin).

an ex-adrenergic blocker, selectively blocks postsynaptic a-adrenergic receptors.

This blocking action decreases sympathetic tone on the vasculature,

dilating arterioles and veins.

3. propranolol (Inderal).

             the only beta-adrenergic medication listed.

4. labetalol hydrochloride (Trandate).

competitively blocks alpha- and beta-receptors.

62. When giving discharge instructions to the client with Raynaud's disease,

the nurse will explain that the expected outcome of taking a beta-adrenergic blocking medication is to control the symptoms by

1. decreasing the influence of the sympathetic nervous system

on the tissues in the hands and feet.

Beta-adrenergic medications block the beta-adrenergic receptors.

Therefore, the expected outcome is to decrease the influence of the sympathetic nervous system on the blood vessels in the hands.

2. decreasing the pain by producing analgesia.

have no analgesic effects.

3. increasing the blood supply to the affected area.

an indirect effect.

4. increasing monoamine oxidase.

do not increase monoamine oxidase,

which does not playa role in Raynaud's disease.

63. A client with Raynaud's disease is scheduled for sympathectomy.

This surgery is performed

1. in the early stages of the disease to prevent further circulatory disturbances.

2. when the disease is controlled by medication.

3. when the client is unable to control stress-related vasospasm.

Medication and stress management are beneficial strategies

to prevent advancement of the disease process.

If the disease is controlled by medication, there is no reason for surgery.

4. when all other treatment alternatives have failed.