In palpating a patient's feet and hands, you note extreme ...

[crobinson2013]

In palpating a patient's feet and hands, you note extreme coolness to the touch. This finding is most consistent with which of the following?
 
  a. Presence of a disorder causing chronic hypoxemia
  b. Reduction in venous return to the right side of the heart
  c. Peripheral vasoconstriction due to inade-quate perfusion
  d. Presence of a disorder causing systemic hypertension

Question 2

A clinician unsuccessfully tried to take the pulse of a patient who is suffering from an asthma attack in the ER.
 
  The patient's breath sounds are diminished to absent bilaterally with a BP of 110 mm Hg systolic and 90 mm Hg diastolic. What can be concluded about this patient's condition?
  1. Abdominal paradox is present.
  2. Lung hyperinflation is present.
  3. Pulsus paradoxus is present.
  4. Pulse pressure is greater than 30 mm Hg.
  a. 2 and 3 only
  b. 1 and 2 only
  c. 2 only
  d. 1, 3, and 4 only

[Kimmy]

Answer to Question 1

ANS: C
When perfusion is poor (as in heart failure or shock), the compensatory vasoconstriction in the extremities helps shunt blood to the vital organs. This reduction in peripheral perfusion causes the extremities to become cool to the touch. The extent to which the coolness to touch extends to-ward the body is an indication of the degree of circulatory failure.

Answer to Question 2

ANS: A
When the pulse pressure is less than 30 mm Hg during spontaneous inhalation, the peripheral pulse is difficult to detect, which is called pulsus paradoxus, or paradoxical pulse. Pulsus para-doxus is the consequence of lung hyperinflation experienced during a severe asthma attack or status asthmaticus.