The nurse is conducting a physical assessment on a client with infective endocarditis (IE). The nurse observes flat, reddened, non-tender maculae on the hands and feet.
What does the nurse understand these to be?
Heberden’s nodes.
Bouchard’s nodes.
Janeway lesions.
Tophi.
The Correct Answer is C
Choice A rationale
Heberden’s nodes are bony swellings that occur at the distal interphalangeal finger joint, a sign of osteoarthritis. They are not associated with infective endocarditis (IE).
Choice B rationale
Bouchard’s nodes are similar to Heberden’s nodes but occur at the proximal interphalangeal finger joint. They are also a sign of osteoarthritis and not associated with IE.
Choice C rationale
Janeway lesions are flat, painless, red or purple spots on the palms of the hands or the soles of the feet. They are associated with IE and are caused by septic emboli which are small clots filled with bacteria. These emboli can lodge in small blood vessels, causing these characteristic lesions.
Choice D rationale
Tophi are hard, uric acid deposits under the skin. They are a sign of chronic gout, not IE.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
The diaphragm is not typically the location of a coarctation of the aorta. The diaphragm is a muscle that helps with breathing and separates the chest cavity from the abdominal cavity.
Choice B rationale
The bifurcation into the common iliac arteries is not typically the location of a coarctation of the aorta. The common iliac arteries are located in the lower part of the aorta and supply blood to the pelvis and legs.
Choice C rationale
The aortic valve is not typically the location of a coarctation of the aorta. The aortic valve is located between the left ventricle of the heart and the aorta.
Choice D rationale
The ductus arteriosus is the correct answer. Coarctation of the aorta often occurs near the ductus arteriosus, a blood vessel that connects the left pulmonary artery to the aorta.
Correct Answer is C
Explanation
The correct answer is choice c. Carry out immediate defibrillation.
Choice A rationale:
Initiating cardiopulmonary resuscitation (CPR) is essential for a client who is unresponsive and without a pulse. However, in the presence of ventricular fibrillation, immediate defibrillation is the priority to restore a viable heart rhythm.
Choice B rationale:
Establishing intravenous (IV) access is important for administering medications during resuscitation. However, it is not the immediate priority when defibrillation is indicated.
Choice C rationale:
Immediate defibrillation is the priority action for a client with ventricular fibrillation who is unresponsive and without a pulse. Defibrillation can quickly restore a normal heart rhythm, which is critical in saving the client’s life.
Choice D rationale:
Checking the client’s latest electrolyte levels can provide valuable information for ongoing treatment but is not the immediate priority in an emergency situation where defibrillation is indicated. Immediate action to restore the heart rhythm is more critical.
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.