A nurse working in an emergency department is caring for a client who has third-degree frostbite to both lower extremities. The nurse should take which of the following actions?

Massage the legs.

Apply dry heat to the legs.

Elevate the legs.

Immerse the legs in cold water.

Answer and Explanation

The Correct Answer is C

A. Massage the legs: This is incorrect. Massage is contraindicated as it can cause further tissue damage and is not appropriate for frostbite.
B. Apply dry heat to the legs: This is incorrect. Dry heat can exacerbate tissue damage. Rewarming should be done using controlled, warm water immersion, not dry heat.
C. Elevate the legs: This is correct. Elevating the legs helps reduce swelling and can prevent further tissue damage. However, rewarming should be done carefully in a controlled environment.
D. Immerse the legs in cold water: This is incorrect. Immersing in cold water would worsen the frostbite. Rewarming should be done using warm (not hot) water, ideally at 37-39°C (98.6-102.2°F), for effective treatment.

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Correct Answer is C

Explanation

A. Increased sweating: This is incorrect. Increased sweating is not typically indicative of internal hemorrhaging. It can be associated with various conditions but is not a specific sign of internal bleeding.
B. Increased redness at the site: This is incorrect. Increased redness would more likely be associated with localized infection or inflammation rather than internal hemorrhaging.
C. Increased abdominal distention: This is correct. Increased abdominal distention can be a sign of internal hemorrhaging, particularly if blood accumulates in the abdominal cavity (hemoperitoneum), leading to abdominal swelling and discomfort.
D. Increased blood pressure: This is incorrect. Internal hemorrhaging often leads to hypotension rather than increased blood pressure, as blood volume decreases and the body attempts to compensate.

A. "It provides an area where clients can be provided a shower and privacy." B. "It provides a centralized area for the triage of all clients as they arrive to the facility." C. "It prevents secondary contamination to the facility and its healthcare providers." D. "It serves as a holding area that isolates the clients who have been exposed to the agent."

Correct Answer is C

Explanation

A. "It provides an area where clients can be provided a shower and privacy." This is incorrect. While decontamination areas may include showers for client decontamination, the primary rationale is more focused on preventing contamination rather than providing privacy.
B. "It provides a centralized area for the triage of all clients as they arrive to the facility." This is incorrect. Centralized triage is important but not the primary reason for a decontamination area.
C. "It prevents secondary contamination to the facility and its healthcare providers." This is correct. The primary rationale for a designated decontamination area is to prevent secondary contamination of the facility and its personnel by removing contaminants from individuals before they enter the healthcare environment.
D. "It serves as a holding area that isolates the clients who have been exposed to the agent." This is incorrect. Isolation may be a component, but the main purpose of decontamination is to prevent contamination spread.

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A nurse working in an emergency department is caring for a client who has third-degree frostbite to both lower extremities. The nurse should take which of the following actions?

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