An adult client exhibits an allergic reaction to an insect bite. The nurse should observe the client's skin for which finding?
Papules.
Wheals.
Fissuring.
Excoriation.
The Correct Answer is B
A. Papules are small, raised, solid lesions, but they are not the typical primary skin lesion in an allergic reaction.
B. Wheals are raised, red, and itchy areas of the skin that appear in response to an allergic reaction, such as from an insect bite. Wheals are a hallmark sign of urticaria (hives) often seen in allergic reactions.
C. Fissuring refers to deep cracks or breaks in the skin, typically seen in conditions like chronic dermatitis or eczema, not in acute allergic reactions.
D. Excoriation involves skin damage caused by scratching and is secondary to itching, not a primary skin lesion of an allergic reaction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Pulse volume is not the same as the presence of a bruit, which is an abnormal sound heard over an artery.
B. A bruit is an abnormal, blowing, or swishing sound heard over an artery, indicating turbulent blood flow, often due to atherosclerosis or narrowing of the artery. Documenting the presence of a bruit on the left and its absence on the right is the correct approach.
C. A strong pulse does not necessarily correlate with the presence of a bruit, and the absence of sound on the right does not confirm occlusion.
D. Occlusion of the artery cannot be confirmed solely based on the absence of a bruit; further diagnostic testing would be required.
Correct Answer is B
Explanation
A. Applying warm blankets to both feet may help improve circulation but is not the most effective method for locating pedal pulses. This approach does not immediately address the difficulty in palpation.
B. Using a Doppler ultrasonic stethoscope is the appropriate action when pedal pulses are not palpable. The Doppler can detect blood flow in cases where pulses are weak or difficult to feel, making it a vital tool in this scenario.
C. Notifying the healthcare provider is necessary if the Doppler fails to detect pulses, but the initial step should be to use the Doppler to assess the pulses before escalating the situation.
D. Palpating pulse points with the legs dependent may assist in enhancing blood flow to the extremities, but it is less reliable than using a Doppler to detect the pulses when they are not palpable.
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.
