A nurse is assisting with the care of an adolescent.
Select 1 condition and 1 finding to fill in each blank in the following sentence.
The adolescent is at risk for developing
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D"}
The adolescent is at risk for developing compartment syndrome as evidenced by edema of toes.
Compartment syndrome is a serious condition where increased pressure within a muscle compartment can lead to decreased blood flow and tissue damage. The presence of moderate toe edema and fluctuating pain levels are concerning signs that may indicate the development of compartment syndrome, which requires prompt assessment and intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Incorrect. Phenytoin is known to be a teratogenic medication, meaning it can cause birth defects. It is important for females of childbearing age to use effective contraception while taking phenytoin and to discuss pregnancy plans with their healthcare provider.
B. Incorrect. Skipping a dose of phenytoin can lead to changes in blood levels of the medication and may result in decreased seizure control. Nausea should be managed with the guidance of the healthcare provider.
C. Incorrect. Phenytoin can require regular monitoring of blood levels, but the frequency of blood work may vary based on the client's individual needs. Blood work is usually done more frequently than every 6 months, especially when starting or adjusting the medication.
D. Correct. Phenytoin can cause gingival hyperplasia, which leads to swollen and overgrown gums. This is a common side effect that clients should be informed about.
Correct Answer is B
Explanation
The correct answer is choiceb. Support the client’s decision to stop the treatment.
Choice A rationale:
While discussing the decision with family can be important, the nurse’s primary responsibility is to respect and support the client’s autonomy and decision-making capacity. Encouraging the client to discuss with family is secondary to supporting their decision.
Choice B rationale:
Supporting the client’s decision to stop treatment respects their autonomy and right to make decisions about their own care.This is a fundamental principle in nursing ethics and patient-centered care.
Choice C rationale:
Discussing alternative treatment methods may be appropriate in some contexts, but in this case, the client has already made a decision to stop dialysis. The nurse should focus on supporting this decision rather than suggesting alternatives.
Choice D rationale:
Asking the facility chaplain to visit the client can be supportive, but it should not be the nurse’s primary action. The nurse should first support the client’s decision and then offer additional support services as needed.
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