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: Assessing the cranial nerves is important, but it is not the immediate next step after implementing droplet precautions for suspected bacterial meningitis.
Choice B reason: Decreasing environmental stimuli can help reduce the risk of seizures and is a supportive measure for a patient with suspected bacterial meningitis.
Choice C reason: Closing the room is part of implementing droplet precautions but is not an action that needs to be initiated by the nurse as it should already be in place.
Choice D reason: Administering an antipyretic may be necessary if the patient has a fever, but it is not the immediate next action after droplet precautions.
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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