A nurse can assess cyanosis in a dark-skinned patient by assessing the color of which body part?
lips and mucous membranes.
sclera.
abdomen
soles of the feet.
The Correct Answer is A
A. Lips and mucous membranes. Cyanosis is best assessed in areas where the skin is thin, and the underlying blood vessels are more visible.
B. Sclera. Sclera is usually white, and cyanosis is not well-assessed here.
C. Abdomen: The abdomen is not an ideal site for assessing cyanosis due to thicker skin and less visible blood vessels.
D. Soles of the feet. The soles of the feet are not reliable for assessing cyanosis due to skin thickness and pigmentation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Depression is more related to a sense of loss or prolonged stress, not immediate perceived threats.
B. Anxiety is an emotional response to a perceived threat, involving worry and fear about potential danger.
C. Fear is a direct response to a known and definite threat, whereas anxiety is more about anticipation of a threat.
D. Anger can result from frustration or perceived injustice but is not primarily driven by perceived threats to self.
Correct Answer is C
Explanation
A. Help the patient interact in nonaddictive activities. While engaging in nonaddictive activities is important for long-term recovery, the primary concern during the detoxification period is managing withdrawal symptoms and ensuring safety.
B. Enroll the patient in Alcoholics Anonymous (AA). Enrolling in AA or similar support groups is beneficial for ongoing recovery, but the focus during detoxification should be on managing acute withdrawal symptoms and safety.
C. Keep the patient safe from aspiration and seizure. During detoxification, patients are at risk for serious complications such as seizures and aspiration due to withdrawal symptoms. Ensuring patient safety by monitoring for these conditions is a primary goal.
D. Help the patient gain insight into the addiction. Gaining insight into addiction is important for long-term recovery but is not the immediate priority during the detoxification period, which focuses on managing physical withdrawal symptoms and ensuring patient safety.
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