The triage nurse in the emergency department is assessing a client who reports pain and swelling in the right lower leg. The client's pain became much worse last night and appeared along with fever, chills, and sweating. The client states, "I hit my leg on the car door 4 or 5 days ago, and the sore is getting bigger" The client has a history of diabetes mellitus type 2. Which condition should the nurse anticipate for this client?

Venous thromboembolism (VTE)

Cellulitis

Arterial insufficiency

Thrombocytopenia

Answer and Explanation

The Correct Answer is B

A. Venous thromboembolism (VTE) - While VTE can cause leg pain and swelling, the presence of fever, chills, and localized trauma history in this scenario points more toward cellulitis.

B. Cellulitis
The client's symptoms, including pain, swelling, fever, chills, and sweating, are indicative of cellulitis, which is a bacterial skin infection. The history of trauma to the leg (hitting the leg on the car door) could have introduced bacteria into the skin, leading to the infection. The client's diabetes mellitus type 2 also increases the risk of developing skin infections due to impaired immune function and circulation. Cellulitis often presents with localized pain, swelling, warmth, redness, and systemic symptoms like fever and chills. Immediate medical evaluation and appropriate antibiotic treatment are necessary for cellulitis.

C. Arterial insufficiency - Arterial insufficiency typically presents with symptoms like intermittent claudication, rest pain, and non-healing wounds due to poor circulation. The symptoms described in the scenario are more consistent with an acute infection (cellulitis) rather than chronic arterial insufficiency.

D. Thrombocytopenia - Thrombocytopenia is a condition characterized by low platelet count and does not directly cause localized pain, swelling, and redness in the leg as described in the scenario.

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Correct Answer is C

Explanation

A. Malignant hypothermia: This is a rare but life-threatening reaction to certain medications used during anesthesia. It doesn't typically manifest with calf edema.

B. Pulmonary embolism: While pulmonary embolism can occur as a complication in some cases, it is characterized by symptoms like sudden shortness of breath, chest pain, and may not directly cause calf edema.

C. Acute compartment syndrome
Increasing edema in the calf of a client with multiple fractures of the leg is a manifestation of acute compartment syndrome. Acute compartment syndrome occurs when there is increased pressure within a muscle compartment, which can lead to reduced blood flow, nerve damage, and tissue hypoxia. The edema and increased pressure can compress blood vessels, nerves, and muscle tissue within the compartment, resulting in symptoms such as severe pain, edema, and potential vascular compromise.

D. Fat embolism syndrome: This syndrome can occur in clients with long bone fractures, but it is characterized by respiratory and neurologic symptoms, not isolated calf edema.

A. "You will need to lie flat for 4 hours following the test." B. "You will need to empty your bladder before the test." C. "You will need to have an IV inserted for the IV dye needed for the scan." D. "You will need to fast for 12 hours before the test."

Correct Answer is B

Explanation

A. There is no need for the client to lie flat for an extended period after a DEXA scan. The procedure is non-invasive and does not require immobilization.

B. Emptying the bladder before the test is essential to ensure a clear and accurate scan of the pelvis and lower spine. A full bladder might obstruct the view and affect the accuracy of the results.

C. DEXA scans do not typically require the use of IV dye. It is a simple X-ray procedure that measures bone density, and no contrast material is usually needed.

D. Fasting is not necessary for a DEXA scan. The procedure does not involve ingesting or injecting any substances that require fasting.

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Naxlex Comprehensive Predictor Exams

A nurse notes increasing edema in the calf of a client who has multiple fractures of the leg. The nurse should recognize that increasing edema is a manifestation of which of the following complications?

Correct Answer is C

Explanation

A nurse is teaching a client who is scheduled for dual-energy x-ray absorptiometry (DEXA) to screen for osteoporosis. Which of the following instructions should the nurse include in the teaching?

Correct Answer is B

Explanation

A nurse is caring for a client with acute pyelonephritis. Which area should the nurse percuss to assess for pain related to pyelonephritis?

The nurse is caring for a client who is diagnosed with an arterial insufficiency ulcer. The nurse should plan interventions to address which priority issue?

A nurse is teaching a client about preventing osteoporosis. Which of the following statements by the client indicates a need for further teaching?

A nurse is teaching a lactose intolerant client at high risk for osteoporosis about dietary measures she can take to increase her calcium level. Which of the following foods should the nurse advise the client to increase in her diet?

A nurse is completing a risk assessment on a new admission. Which standardized scale will the nurse use to calculate the client's risk for pressure ulcers?

A nurse is talking with a young adult client who has a family history of osteoporosis, Which health promotion activity should the nurse recommend as a possible preventive measure?

The nurse understands that certain patients are more susceptible to pressure ulcer development. Which clients should the nurse identify as being at an increased risk for this health problem? Select all that apply.