A nurse in an emergency department is assessing a client who was biten on the left leg by a poisonous snake. The client has placed elastic bandages snugly above and below the bite marks and is in no apparent distress. Which of the following actions should the nurse take?

Remove both of the elastic bandages from the leg.

Discharge the client.

Obtain a prescription for the appropriate anti-venom.

Obtain a prescription for pain medication.

Answer and Explanation

The Correct Answer is C

Choice A: Removing the elastic bandages is not recommended. These bandages help slow the spread of venom by compressing the lymphatic vessels. Removing them could worsen the envenomation.

Choice B: This is incorrect. The nurse should not discharge the client, as they may develop serious complications from the snake bite, such as swelling, bleeding, infection, or shock. The client should be monitored closely and treated accordingly.

Choice C: This is the correct action. Antivenom treatment is crucial for serious snake envenomation. The sooner it can be administered, the better the outcome.

Choice D: While pain management is important, it is not the priority in this situation. Antivenom takes precedence over pain medication.

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Correct Answer is ["A","B","D","F"]

Explanation

Choice A: Weakened gag reﬂex is a complication of cervical spinal cord injury. The gag reﬂex is a protective mechanism that prevents choking and aspiration. It is controlled by the cranial nerves IX and X, which originate from the brainstem. A cervical spinal cord injury can impair the transmission of nerve impulses from the brainstem to the pharynx and larynx, resulting in a reduced or absent gag reﬂex. This can increase the risk of aspiration pneumonia and respiratory failure.

Choice B: Hyperthermia is a complication of cervical spinal cord injury. Hyperthermia is an abnormally high body temperature, which can be caused by infection, inﬂammation, or environmental factors. A cervical spinal cord injury can disrupt the sympathetic nervous system, which regulates body temperature by controlling blood ﬂow, sweating, and shivering. This can lead to impaired thermoregulation and hyperthermia, especially in hot and humid environments.

Choice C: Absence of bowel sounds is not a complication of cervical spinal cord injury. Bowel sounds are audible noises produced by the movement of gas and ﬂuid through the intestines. They are inﬂuenced by factors such as diet, activity, medication, and bowel motility. A cervical spinal cord injury does not directly aﬀect bowel sounds, but it

can cause neurogenic bowel dysfunction, which is a loss of voluntary control over bowel movements. This can lead to constipation, fecal impaction, or incontinence.

Choice D: Paralysis is a complication of cervical spinal cord injury. Paralysis is a loss of voluntary muscle movement and sensation in a part of the body. It is caused by damage to the motor and sensory neurons that carry signals from the brain to the muscles and skin. A cervical spinal cord injury can damage the neurons that innervate the arms, trunk, legs, and pelvic organs, resulting in quadriplegia or tetraplegia, which is paralysis of all four limbs and the trunk.

Choice E: Polyuria is not a complication of cervical spinal cord injury. Polyuria is an excessive production of urine, which can be caused by diabetes mellitus, diabetes insipidus, diuretics, or kidney disease. A cervical spinal cord injury does not directly aﬀect urine production, but it can cause neurogenic bladder dysfunction, which is a loss of voluntary control over bladder function. This can lead to urinary retention, overﬂow incontinence, or reﬂex incontinence.

Choice F: Hypotension is a complication of cervical spinal cord injury. Hypotension is an abnormally low blood pressure, which can be caused by blood loss, dehydration, shock, or medication. A cervical spinal cord injury can impair the sympathetic nervous system, which regulates blood pressure by controlling heart rate, cardiac output, and vascular tone. This can lead to neurogenic shock, which is a type of distributive shock characterized by hypotension and bradycardia.

A. Hct 45% B. Platelets 160,000/mm³ C. WBC 1,700/mm³ D. Hgb 14.7 g/dL

Correct Answer is C

Explanation

Choice A: Hct 45% is not a value that the nurse should report to the provider. Hct, or hematocrit, is the percentage of red blood cells in the total blood volume. The normal range for Hct is 37% to 51% for men and 32% to 45% for women. Hct 45% is within the normal range and does not indicate any abnormality.

Choice B: Platelets 160,000/mm³ is not a value that the nurse should report to the provider. Platelets, or thrombocytes, are cell fragments that help with blood clotting and hemostasis. The normal range for platelets is 150,000 to 450,000/mm³. Platelets 160,000/mm³ is within the normal range and does not indicate any abnormality.

Choice C: WBC 1,700/mm³ is a value that the nurse should report to the provider. WBC, or white blood cells, are cells that fight infection and inﬂammation. The normal range for WBC is 4,500 to 11,000/mm³. WBC 1,700/mm³ is below the normal range and indicates leukopenia, which is a low number of white blood cells. Leukopenia can be caused by various conditions, such as viral infections, autoimmune disorders, bone marrow suppression, or chemotherapy. Leukopenia can increase the risk of infection and sepsis and requires prompt evaluation and treatment.

Choice D: Hgb 14.7 g/dL is not a value that the nurse should report to the provider. Hgb, or hemoglobin, is a protein in red blood cells that carries oxygen to the tissues. The normal range for Hgb is 13.5 to 17.5 g/dL for men and 12.0 to 15.5 g/dL for women. Hgb 14.7 g/dL is within the normal range and does not indicate any abnormality.

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A nurse in an emergency department is assessing a client who was biten on the left leg by a poisonous snake. The client has placed elastic bandages snugly above and below the bite marks and is in no apparent distress. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the emergency department is monitoring a client who has a cervical spinal cord injury from a fall. The nurse should monitor the client for which of the following complications? (Select all that apply.)

Correct Answer is ["A","B","D","F"]

Explanation

A nurse is reviewing a client's laboratory values. Which of the following values should the nurse report to the provider?

Correct Answer is C

Explanation

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