A nurse is assessing a client who has a left lower arm fracture. Which of the following findings indicates impaired venous return in the client’s affected arm?
Acute pain
Ecchymosis of the surrounding skin
Increasing edema
Diminishing distal pulse
The Correct Answer is C
Choice A reason: Acute pain is expected with a fracture but does not specifically indicate impaired venous return.
Choice B reason: Ecchymosis, or bruising, can occur with a fracture due to bleeding into the tissue but is not a direct indicator of venous return issues.
Choice C reason: Increasing edema is a sign of impaired venous return as it indicates a buildup of fluid in the tissues, which can occur if the veins are not effectively returning blood to the heart.
Choice D reason: A diminishing distal pulse could indicate arterial impairment rather than venous return issues.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Applying a tourniquet just below the elbow is not recommended as the first line of action for a deep laceration unless there is life-threatening hemorrhaging that cannot be controlled by direct pressure. Tourniquets are used as a last resort because they can cause tissue damage.
Choice B reason: Elevating the limb and applying ice can help reduce bleeding and swelling. Elevation uses gravity to help reduce blood flow to the injury, and the cold from the ice constricts blood vessels, further helping to control bleeding and reduce swelling.
Choice C reason: Cleaning the wound is important, but it should not be the first action taken. The initial focus should be on stopping the bleeding. Once bleeding is controlled, the wound can be cleaned to prevent infection.
Choice D reason: Applying pressure directly to the wound with a clean cloth or bandage is the first step in controlling bleeding. However, the question specifies applying pressure above the wound, which would not be effective in controlling bleeding from the wound itself.
Correct Answer is A
Explanation
Choice A reason: Immunoglobulin E (IgE) is associated with allergic reactions. A RAST test measures the level of allergen specific IgE antibodies in the blood. An elevation in IgE indicates sensitization to a particular allergen and a positive result for the allergy.
Choice B reason: Immunoglobulin M (IgM) is usually the first antibody produced by the immune system when it detects an infection. It is not typically associated with the detection of allergies.
Choice C reason: Immunoglobulin A (IgA) plays a critical role in mucosal immunity and is found in high concentrations in the mucous membranes, particularly those lining the respiratory passages and the gastrointestinal tract, but it is not used as an indicator in RAST testing for allergies.
Choice D reason: Immunoglobulin G (IgG) is the most abundant type of antibody and is involved in the recognition and removal of pathogens. It is not specific to allergic response detection in RAST testing.
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