17-year-old male arrives at the emergency department following playing baseball. He slid into a base, felt a 'pop', and had pain in his right ankle.

The client reports pain of 7 out of 10 in his right ankle, which is described as throbbing. Right pedal pulse was 2+, and the sensation was intact.

The client had a limited and painful range of motion in his ankle. Significant swelling and bruising in the ankle were observed.

Exhibits

The emergency department nurse cares for a client with right ankle pain.
Complete the statement below:

While teaching the client how to use crutches, the nurse should instruct the client to ambulate using the
dropdown
and based on the client
dropdown
.

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"D"}

Choice A rationale: A three-point gait is used when one leg is weaker or injured and cannot bear weight. The client should place the crutches about 12 inches in front of the feet and lean forward on the crutches. Then, the client should lift the injured leg and

swing the body forward between the crutches, landing on the uninjured leg. The client should not put any weight on the injured ankle, as ordered by the physician.

Choice B rationale: A four-point gait is used when both legs can bear some weight, but one is weaker than the other.

Choice C rationale: A swing-through gait is used when both legs can bear weight, but need assistance with balance and coordination.

Choice D rationale: A two-point gait is used when both legs have equal strength and can bear full weight.

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Correct Answer is B

Explanation

Choice A rationale: Redness briefly after removing the appliance might be common due to increased blood flow but does not necessarily indicate an issue.

Choice B rationale: A deep red-purple stoma color can suggest impaired blood supply to the stoma and requires immediate attention.

Choice C rationale: The consistency of output from the colostomy may vary based on the site and type of colostomy and might not necessarily be concerning.

Choice D rationale: The length of the stoma can vary and usually depends on the type of colostomy, and 1/2 inch above the abdomen is within an acceptable range.

A. arterial blood gas (ABG) findings B. oxygen saturation level C. white blood cell differential D. red blood cells (RBCs) and hemoglobin count findings

Correct Answer is A

Explanation

Choice A rationale: Arterial blood gas (ABG) findings provide direct information about oxygenation and acid-base balance in the blood, which can indicate hypoxemia and metabolic acidosis.

Choice B rationale: Oxygen saturation level provides information about oxygen saturation in the blood but doesn't give a complete assessment of acid-base balance or other gases in the blood.

Choice C rationale: White blood cell differential assesses different types of white blood cells and is not directly related to evaluating hypoxemia or metabolic acidosis.

Choice D rationale: Red blood cells (RBCs) and hemoglobin count findings are important but do not directly assess hypoxemia or metabolic acidosis.

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Naxlex Comprehensive Predictor Exams

The nurse is most likely to report which finding to the primary care provider for a client who has an established colostomy?

Correct Answer is B

Explanation

The nurse is concerned about the risks of hypoxemia and metabolic acidosis in a client who is in shock. What finding should the nurse analyze for evidence of hypoxemia and metabolic acidosis in a client with shock?

Correct Answer is A

Explanation

The nurse exploring cranial nerves function and observes the following reaction: The nurse documents that the client has a:

The nurse working in a postoperative surgical clinic is assessing a woman who had a left radical mastectomy for breast cancer. Which factor puts this client at greatest risk for developing lymphedema?

Which complication is suspected in a client whose blood sugar is less than 30 mg/dL?

When providing care for a client receiving peritoneal dialysis. While draining the dialysate the nurse notices that the efluent is cloudy. Which intervention is most important for the nurse to carry out at this moment?

The nurse reviews the laboratory reports of a client and concludes that the client has diabetes. Which finding helped the nurse to reach this conclusion?

The nurse is reviewing the record of a female client with Crohn's disease. Which stool characteristics should the nurse expect to note documented in the client's record?

The nurse is caring for a client suspected of having an endocrine disorder. Exhibits Based on the client's laboratory data, the client is at the highest risk for which condition?

A client is admitted to the hospital with a traumatic brain injury after his head violently struck a brick wall during a gang fight. Which finding is most important for the nurse to assess further?