A client seeks medical attention for intermittent signs and symptoms that suggest a diagnosis of Raynaud’s disease. The nurse should assess the trigger of these signs/symptoms by asking which?
“Does drinking coffee or ingesting chocolate seem related to the episodes?”
“Does being exposed to heat seem to cause the episodes?”
“Do the signs and symptoms occur while you are asleep?”
“Have you experienced any injuries that have limited your activity levels lately?”
The Correct Answer is A
Choice A rationale
Drinking coffee or ingesting chocolate can trigger Raynaud’s disease symptoms. Both caffeine and chocolate can cause vasoconstriction, which can exacerbate the symptoms of Raynaud’s disease.
Choice B rationale
Being exposed to heat is not a common trigger for Raynaud’s disease. The condition is typically triggered by cold temperatures or stress.
Choice C rationale
Symptoms of Raynaud’s disease do not typically occur while asleep. The condition is more likely to be triggered by cold or stress during waking hours.
Choice D rationale
Injuries that limit activity levels are not directly related to the triggers of Raynaud’s disease. The primary triggers are cold temperatures and stress.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice D rationale
Positioning the client on the abdomen for 20 to 30 minutes twice a day helps prevent hip flexion contractures. This position stretches the hip flexor muscles, reducing the risk of contractures and promoting better range of motion.
Choice A rationale
Maintaining the client in a supine position does not effectively prevent hip flexion contractures. It is important to vary the client’s position to avoid stiffness and promote mobility.
Choice B rationale
Maintaining a high-Fowler’s position when the client is in bed can increase the risk of hip flexion contractures. This position keeps the hip flexed, which can lead to contractures over time.
Choice C rationale
Elevating the stump on a pillow can help reduce swelling but does not address the prevention of hip flexion contractures. The focus should be on positioning that stretches the hip flexors.
Correct Answer is B
Explanation
Choice A rationale
9 percent is the percentage of total body surface area (TBSA) for one arm (front or back) or the head and neck combined. Since the burns are on the front and back of both arms, this percentage is too low.
Choice B rationale
18 percent is the correct percentage of TBSA for burns on the front and back of both arms. Each arm accounts for 9 percent of TBSA, so both arms together account for 18 percent.
Choice C rationale
36 percent is the percentage of TBSA for burns on both legs (front and back) or the entire trunk (anterior and posterior). This percentage is too high for burns on the front and back of both arms.
Choice D rationale
54 percent is the percentage of TBSA for burns on the entire trunk (anterior and posterior) and one leg (front and back). This percentage is too high for burns on the front and back of both arms.
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