A client drove himself to the urgent care center for, "Legs that look like balloons and difficulty walking." The nurse assesses 4+ edema of both legs based upon which finding?

Very deep pitting indentation of legs lasts several minutes.

Deep pitting indentation of legs lasts a few minutes.

Mild pitting, no perceptible swelling of the legs.

Moderate pitting: indentation of legs subsides rapidly.

Answer and Explanation

The Correct Answer is A

A.   4+ edema is characterized by very deep pitting, where the indentation remains for an extended period (several minutes), indicating severe fluid accumulation in the tissue.
B.   Deep pitting that lasts for a few minutes is more consistent with 2+ or 3+ edema, not the severe 4+ edema described.
C.   Mild pitting with no perceptible swelling does not align with 4+ edema; this level of pitting suggests minimal fluid accumulation.
D.   Moderate pitting where the indentation subsides rapidly is indicative of 2+ edema, not the profound swelling described as 4+ edema.

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Correct Answer is A

Explanation

A. Heart failure can lead to fluid accumulation in the legs due to the heart's inability to effectively pump blood, causing increased pressure in the veins.
B. Excess fluid retention or consumption might cause edema, but heart failure specifically impacts the heart's pumping function.
C. Excess fluid consumption might contribute to temporary edema, but severe bilateral lower extremity edema is more likely due to a systemic issue like heart failure.
D. While a pulmonary embolism can lead to edema in the legs, it typically presents with sudden onset and might not present with bilateral edema from feet to knees.

A. "This vaccine is only for individuals who have not yet started to become sexually active." B. "The vaccine cannot protect you if you already have HPV infection." C. "The HPV vaccine is for individuals ages 9 to 26 years, so we can start that today." D. Let's check with the physician to see if you are a candidate for the vaccine.

Correct Answer is B

Explanation

A. HPV vaccination is recommended for both sexually active and non-sexually active individuals for preventive purposes. This statement restricts the vaccine unnecessarily.
B. This statement is correct. The HPV vaccine works best if administered before exposure to the virus, so it is not effective in treating existing HPV infections or genital warts.
C. While true that the HPV vaccine is typically recommended for individuals within a certain age range, this statement doesn't address the client's specific query about getting rid of existing genital warts.
D. Involving the physician in vaccine candidacy is a good step but doesn't directly address the client's query about HPV infection and genital warts.

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A client drove himself to the urgent care center for, "Legs that look like balloons and difficulty walking." The nurse assesses 4+ edema of both legs based upon which finding?

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Correct Answer is A

Explanation

A nurse is taking a health history from a female client. The client asks to get the vaccine for human papillomavirus (HPV) to get rid of genital warts. Which of the following statements should be the nurse's best response?

Correct Answer is B

Explanation

The nurse is taking a health history from a client. The client tells the nurse that. "It feels like the room is spinning." How should the nurse document this finding?

A client drove himself to the urgent care center for, "Legs that look like balloons and difficulty walking." The nurse assesses 4+ edema of both legs based upon which finding?

A client comes to the clinic and reports having weakness in the left arm and leg for the past week. The nurse should perform which type of neurological exam?

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