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    Ngu Hesi Rn Compass Exit Proctored Exam

    An older adult client who had an aortic aneurysm repair today is transferred from intensive care to a medical-surgical unit on the first postoperative day. While assessing the client, the nurse notes edema of both lower extremities and is unable to palpate the pedal pulses. Which intervention should the nurse implement?

    Explanation & Rationale

    Rationale: A. Use a bed cradle to support linen above the legs: A bed cradle helps prevent pressure from linens on the legs, but it does not address absent or difficult-to-palpate pulses. This intervention is supportive but not diagnostic or priority-focused. B. Use a Doppler ultrasound to reassess the pulses: When pedal pulses cannot be palpated, a Doppler allows accurate assessment of blood flow and perfusion. Prompt evaluation is essential to detect potential arterial compromise or postoperative complications, such as thrombosis or edema-related vascular obstruction. C. Elevate the extremities above the level of the heart: Elevation reduces edema but may worsen arterial perfusion if pulses are already absent. Before positioning, confirming circulation with Doppler assessment ensures interventions do not exacerbate ischemia. D. Wrap the lower extremities with warm blankets: Warming may improve comfort and circulation slightly, but it does not provide objective assessment of vascular status or address potential postoperative vascular compromise.

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