Question
Question 1
The nurse is performing an assessment on an adult. The adult's vital signs are normal and the
capillary refill time is 5 seconds.
What should the nurse do next?
Ask the patient about a past history of frostbite.
Suspect that the patient has a venous insufficiency problem.
Consider this a delayed capillary refill time and investigate further.
Consider this a normal capillary refill time that requires no further assessment.
Question 2
During an assessment, a patient tells the nurse that her fingers often change color when she goes
out in cold weather. She describes these episodes as her fingers first turning white, then blue,
then red with a burning, throbbing pain. The nurse suspects that she is experiencing:
Lymphadema
Raynauds disease
Venous thrombosis
Chronic arterial insufficiency
Question 3
During palpation of the anterior chest wall, the nurse notices a coarse, crackling sensation over
the skin surface. On the basis of these findings, the nurse suspects:
tactile fremitus