A nurse is caring for a client who has diabetic neuropathy of the lower extremities and has a new prescription for a heating pad. The prescription reads, "Apply to the left foot for 20 min." Which of the following actions should the nurse take?
Contact the provider to clarify the prescription.
Complete a Semmes Weinstein monofilament test before applying the heating pad.
Observe the skin 10 min after the start of treatment.
Apply the heating pad as prescribed by the provider.
The Correct Answer is A
Choice A reason: The nurse should contact the provider to clarify the prescription because applying heat to an area with impaired sensation can cause burns or tissue damage. The nurse should also educate the client about the risks of using heat therapy and alternative methods to relieve pain.
Choice B reason: The Semmes Weinstein monofilament test is used to assess the sensation of light touch in clients with peripheral neuropathy. The nurse should perform this test before applying any intervention that could affect the skin integrity, such as heat, cold, or compression.
Choice C reason: Observing the skin 10 min after the start of treatment is not sufficient to prevent complications from heat therapy. The nurse should monitor the skin continuously and check for signs of redness, blisters, or burns.
Choice D reason: Applying the heating pad as prescribed by the provider is not appropriate for a client with diabetic neuropathy of the lower extremities. Heat can increase blood flow and inflammation in the affected area, which can worsen the condition and increase the risk of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: This is incorrect because applying lotion between the toes can create a moist environment that promotes fungal growth and infection. The client should apply lotion to the feet but avoid the areas between the toes.
Choice B: This is incorrect because wearing open-toe shoes can expose the feet to injury and infection. The client should wear well-fitting, closed-toe shoes that protect the feet and prevent pressure ulcers.
Choice C: This is correct because wearing cotton socks can help keep the feet dry and prevent fungal infections. Cotton socks also provide cushioning and reduce friction.
Choice D: This is incorrect because rounding the corners of the toenails can cause ingrown nails, which can lead to infection and ulceration. The client should trim the toenails straight across and file any sharp edges.
Correct Answer is B
Explanation
Choice A reason: Nonpalpable area of redness, less than 5 mm (0.2 in) in diameter is a negative result for the tuberculin skin test, which means that the client does not have tuberculosis infection or exposure.
Choice B reason: Palpable area of induration, greater than 10 mm (0.4 in) in diameter is a positive result for the tuberculin skin test, which means that the client has tuberculosis infection or exposure and needs further testing, such as chest x-ray or sputum culture, to confirm the diagnosis and rule out active disease.
Choice C reason: Area of ecchymosis, greater than 12 mm (0.5 in) in diameter is not a relevant finding for the tuberculin skin test, as it indicates bruising or bleeding under the skin that may be caused by trauma or coagulation disorder.
Choice D reason: Tenderness at the injection site is not a relevant finding for the tuberculin skin test, as it indicates inflammation or irritation of the skin that may be caused by needle insertion or allergic reaction.
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