A nurse is assessing a patient who is experiencing peripheral neurovascular dysfunction. What assessment findings are most consistent with this diagnosis?
A) Hot skin with a capillary refill of 1 to 2 seconds
B) Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin
C) Pain, diaphoresis, and erythema
D) Jaundiced skin, weakness, and capillary refill of 3 seconds
Ans: B
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Indicators of peripheral neurovascular dysfunction include pale, cyanotic, or mottled skin with a cool temperature; capillary refill greater than 3 seconds; weakness or paralysis with motion; and paresthesia, unrelenting pain, pain on passive stretch, or absence of feeling. Jaundice, diaphoresis, and warmth are inconsistent with peripheral neurovascular dysfunction.
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