When assessing capillary refill the color returns within a few seconds. What does this indicate?
the patient can respond to painful stimuli
the status of peripheral circulation
the patient has cardiac or respiratory dysfunction
the patient is cold
The Correct Answer is B
A. The patient can respond to painful stimuli:
This relates to neurological response, not capillary refill.
B. The status of peripheral circulation:
Capillary refill time reflects peripheral perfusion and circulatory status.
C. The patient has cardiac or respiratory dysfunction:
While prolonged capillary refill could suggest such issues, a normal refill does not confirm them.
D. The patient is cold:
Cold temperature may prolong capillary refill, but color returning within a few seconds indicates adequate circulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Return to do a re-assessment in 30 minutes:
Delays addressing the finding. The nurse must determine if the crackles are transient or persistent.
B. Inform the co-assigned nurse:
Not a priority action. The nurse should reassess directly before involving others.
C. Ask the patient if he needs his puffer:
Puffers are used for bronchoconstriction; crackles are usually not treated this way unless wheezing is present.
D. Instruct the patient to take a few breaths and cough:
This helps determine if the crackles are transient (e.g., atelectasis) or indicative of a more serious issue (e.g., fluid overload). If they clear, it’s likely atelectasis.
Correct Answer is ["A","D","E"]
Explanation
A. Protection from bacterial intrusion:
The skin is a first-line defense against infection.
B. Increasing dehydration through water loss:
Incorrect. The skin prevents excess water loss; it is a barrier, not a source of dehydration.
C. Decreasing the wastes excreted:
Incorrect. Skin helps excrete wastes (e.g., urea, salts), not reduce excretion.
D. Regulation of body temperature:
Skin sweats and vasodilates/vasoconstricts to maintain thermal balance.
E. Support of wound healing:
Skin contains cells involved in tissue regeneration and repair.
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