A nurse is assessing a client's lower extremities and notes 6 mm pitting edema. Which of the following is appropriate documentation of this assessment finding?
1+
4+
3+
2+
The Correct Answer is C
A. 1+ pitting edema is mild, with a slight indentation.
B. 4+ pitting edema is severe, with a deep indentation that lasts a long time.
C. 3+ pitting edema is moderate, with a deeper indentation that takes some time to rebound.
D. 2+ pitting edema is moderate, with a slight indentation that rebounds fairly quickly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["150"]
Explanation
The question is about calculating the IV infusion rate for a given solution and volume.
The formula for the infusion rate is: (volume in mL / time in hours) x drop factor in gtts/mL = infusion rate in gtts/min
The drop factor is usually given on the IV tubing package and varies depending on the type of tubing used.
For this question, we can assume a drop factor of 15 gtts/mL, which is common for macrodrip tubing.
Plugging in the numbers, we get: (1200 mL / 8 hr) x 15 gtts/mL = 2250 gtts/hr
To convert from gtts/hr to mL/hr, we divide by the drop factor: 2250 gtts/hr / 15 gtts/mL = 150 mL/hr
Therefore, the nurse should set the IV pump to deliver 150 mL/hr.
Correct Answer is C
Explanation
A. Opening the first flap of the sterile kit away from the body helps maintain the sterility of the contents.
B. The sterile field should be above waist level to avoid contamination.
C. Placing dry, sterile supplies 1/2 inch from the edge of the sterile field helps prevent contamination of the items.
D. Sterile gloves should be donned before preparing the sterile field to avoid contamination.
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