A nurse at an urgent care center is assisting with the care of a client who has hypothermia after exposure to frigid water. Which of the following actions should the nurse take first?
Apply a heating pad to the client's neck.
Provide the client with dry clothing.
Offer the client a warm beverage.
Wrap the client in warm blankets.
The Correct Answer is B
A. Apply a heating pad to the client's neck: Direct application of heat to the skin, especially in localized areas like the neck, can cause rapid vasodilation, leading to a dangerous drop in blood pressure and potential cardiac complications. It also increases the risk of burns on cold-numbed skin.
B. Provide the client with dry clothing: Removing wet clothing and replacing it with dry garments is the first priority in managing hypothermia. Wet clothes accelerate heat loss through conduction and evaporation. Stopping further heat loss is essential before attempting active rewarming.
C. Offer the client a warm beverage: While offering warm fluids can help increase core temperature and provide comfort, it is not the first priority. This intervention is more appropriate after ensuring the client is dry and wrapped in warm coverings.
D. Wrap the client in warm blankets: Wrapping the client in warm blankets is a critical intervention for passive external rewarming. However, it comes after the initial step of removing wet clothes to prevent ongoing heat loss. Blankets are most effective once the source of heat loss has been eliminated.
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Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Explanation
- Aspiration: The client reports food getting stuck in the mouth and has a hoarse voice, which are classic signs of dysphagia (difficulty swallowing). Dysphagia significantly increases the risk for aspiration, where food or liquid enters the airway instead of the esophagus.
- Neurological status: The client also has left-sided weakness, suggesting a neurologic impairment (possibly from a stroke or similar event), which can affect swallowing coordination and airway protection.
Correct Answer is B
Explanation
A. "I should stop receiving Papanicolaou tests once I reach menopause”: Discontinuing Pap tests solely based on menopause is not recommended. Screening continues until at least age 65, depending on the individual's health history and prior screening results. Regular cervical cancer screening is important for early detection, even after menstruation stops.
B. "I might have headaches due to a decline in my estrogen levels”: Fluctuating and declining estrogen levels during perimenopause can trigger headaches or worsen existing ones. Hormonal changes affect blood vessels and neurotransmitters, contributing to the development of migraines or tension headaches in many women during this stage.
C. "The best time to perform a breast self-examination is on the first day of my period”: The ideal time is 7 to 10 days after the start of the menstrual period, when hormonal influence on breast tissue is minimal. Performing it on the first day of menstruation may result in increased tenderness and swelling, making it harder to detect abnormalities.
D. "I can expect to have regular periods until I am in menopause.": Perimenopause is typically marked by irregular menstrual cycles due to hormonal shifts. Periods may become lighter, heavier, more or less frequent before stopping altogether.
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