A client who was recently diagnosed with Raynaud's disease is concerned about pain management. Which nursing instruction should the nurse provide?

Return appointments will be needed for IV medication.

Wearing gloves when handling cold items guards against painful spasms.

Enrolling in a pain clinic can provide pain relief alternatives

Painful areas should be rubbed gently until the pain subsides.

Answer and Explanation

The Correct Answer is B

A. Return appointments will be needed for IV medication:
This statement does not address the specific concern related to pain management in Raynaud's disease, and routine IV medication may not be the primary approach for pain relief in this condition.

B. Wearing gloves when handling cold items guards against painful spasms:
This is the correct answer. Raynaud's disease is characterized by vasospasm of small arteries, often triggered by exposure to cold or stress. Wearing gloves helps to minimize exposure to cold and can prevent painful spasms associated with Raynaud's.

C. Enrolling in a pain clinic can provide pain relief alternatives:
While pain clinics can offer various pain management strategies, the specific recommendation for Raynaud's disease involves minimizing exposure to cold and stress rather than enrolling in a pain clinic.

D. Painful areas should be rubbed gently until the pain subsides:
Rubbing painful areas may not be recommended, as it can potentially aggravate vasospasm in individuals with Raynaud's disease. The emphasis is on preventing triggers like cold exposure.

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Correct Answer is C

Explanation

A. Increasing anxiety:
While emotional and psychological aspects are important in holistic care, immediate intervention is usually required for physiological concerns. Increasing anxiety may need attention, but it is not as urgent as addressing potential respiratory issues.

B. Inappropriate laughter:
Changes in emotional expression, such as inappropriate laughter, can occur in ALS due to involvement of upper motor neurons. While notable, it may not be as urgent as addressing respiratory concerns.

C. Weakened cough effort.
In ALS, respiratory muscles can become affected as the disease progresses, leading to respiratory complications. Weakened cough effort is concerning because it can indicate potential respiratory muscle weakness, which may lead to difficulty clearing secretions and an increased risk of respiratory compromise or infection.

D. Asymmetrical weakness:
Asymmetrical weakness is a common feature of ALS, but it may not necessarily warrant immediate intervention unless there are sudden changes or signs of acute distress. Respiratory symptoms, such as weakened cough effort, often require more immediate attention.

A. Increased temperature to lower extremity. B. Right foot pale with sluggish capillary refill. C. Circumferential edema of right foot. D. Complaint of throbbing right leg pain

Correct Answer is B

Explanation

A. Increased temperature to the lower extremity:
While increased temperature could indicate inflammation or infection, it is not as immediately concerning as impaired circulation.

B. Right foot pale with sluggish capillary refill.
This finding suggests a potential impairment in blood flow to the right foot, which could be due to complications such as compartment syndrome or impaired circulation. Compartment syndrome is a serious condition that occurs when there is increased pressure within a muscle compartment, leading to reduced blood flow. Pale color and sluggish capillary refill indicate compromised circulation and require prompt intervention to prevent further damage.

C. Circumferential edema of the right foot:
Edema is a common finding after a fracture and cast application. However, in the context of pale color and sluggish capillary refill, it may indicate increased pressure within the compartment, requiring immediate attention.

D. Complaint of throbbing right leg pain:
Pain is a common complaint after a fracture, and throbbing pain may be expected. However, the priority is to address the potential compromise in circulation indicated by the pale color and sluggish capillary refill.

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A client who was recently diagnosed with Raynaud's disease is concerned about pain management. Which nursing instruction should the nurse provide?

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Naxlex Comprehensive Predictor Exams

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