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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Administer pain medication: Pain management is not the primary intervention for exposure to anthrax; the focus should be on addressing the disease directly.
B. Administer antibiotic therapy: This is correct. Post-exposure prophylaxis with antibiotics is crucial in preventing the development of anthrax, especially after exposure to spores.
C. Administer an antiviral medication: This is incorrect. Anthrax is caused by bacteria, not viruses, so antiviral medications are not effective.
D. Administer an antitoxin: While antitoxins are used in treating symptomatic anthrax, the immediate and appropriate action for exposure is to start antibiotic therapy.
Correct Answer is C
Explanation
A. Allow a drinking glass on the client's meal tray: This is incorrect. Allowing objects that could potentially be used for self-harm is unsafe. All items on the client's meal tray should be carefully reviewed to ensure they do not pose a risk.
B. Place the client in four-point restraints: This is incorrect. Restraints are used as a last resort and should only be applied following a thorough assessment of the client's needs and risks, considering less restrictive measures first.
C. Inspect the client's personal belongings: This is correct. Inspecting personal belongings is crucial to ensure that the client does not have items that could be used for self-harm. This step helps in identifying and removing potential hazards.
D. Assign the client to a private room: This is incorrect. Assigning a client to a private room might not be appropriate as it could isolate the client and reduce opportunities for observation and intervention. A safer approach is to place the client in a room where they can be closely monitored, typically a shared room with staff supervision.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.