Question 1:
A nurse in an urgent care center is caring for a client who fell and injured her
ankle. The ankle appears swollen and ecchymotic. Which of
... [Show More] the following
interventions should the nurse take? (Select all that apply)
A. Apply a compression bandage to the client's ankle.
B. Apply heat to the client's ankle.
C. Encourage the range of motion of the client's foot.
D. Elevate the client's foot.
E. Check the client's toes for color, temperature, and sensation.
Show correct answer and explanation
Explanation
These are the correct interventions that the nurse should take. Applying a
compression bandage to the client's ankle can help reduce swelling and provide
support to the injured area. Elevating the client's foot can also help reduce
swelling by promoting venous return. Checking the client's toes for color,
temperature, and sensation is important to assess for any potential nerve or
vascular damage.
Applying heat to the client's ankle is not recommended as it can increase
swelling and inflammation. Encouraging range of motion of the client's foot is
also not recommended as it can cause further injury to the affected area.
Question 2:
While collecting data from a client who has a cast on his right leg, a nurse
locates an area on the cast that feels warm to the touch. Which of the following
findings should the nurse identify as a complication to the client's condition?
A. Uneven cast drying
B. Infection
C. Pressure from the cast
D. Poor circulation
Show correct answer and explanation
Explanation
The nurse should identify infection as a complication to the client's condition. A
warm area on the cast could indicate the presence of an underlying infection.
The warmth could be due to an increase in blood flow to the area as the body
tries to fight off the infection.
Uneven cast drying, pressure from the cast, and poor circulation are not
complications that would cause a warm area on the cast. Uneven cast drying
could cause discomfort but would not result in warmth. Pressure from the cast
could cause skin breakdown but would not result in warmth. Poor circulation
could cause coolness or pallor but would not result in warmth.
Question 3:
A nurse is collecting data from a client who has rheumatoid arthritis. Which of
the following is an expected finding for this client?
A. Tophi
B. Boutonniere deformity
C. Osteoma
D. Heberden's nodules
Show correct answer and explanation
Explanation
Boutonniere deformity is an expected finding for a client who has rheumatoid
arthritis. It is a type of hand deformity that can occur in people with rheumatoid
arthritis. It is characterized by a bent middle finger joint and a hyperextended
fingertip.
Tophi, osteoma, and Heberden's nodules are not expected findings for a client
who has rheumatoid arthritis. Tophi are deposits of uric acid crystals that can
occur in people with gout. Osteoma is a benign bone tumor. Heberden's nodules
are bony growths that can occur in people with osteoarthritis.
Question 4: [Show Less]