A nurse is collecting data from a client who has a long leg cast on his left leg. Which of the following findings is the priority?

Ecchymosis on the inner left thigh

One fingerbreadth of space between the cast and the skin

Diminished pulses on the aﬀected extremity

Client report of muscle spasms of the left leg

Answer and Explanation

The Correct Answer is C

c. Diminished pulses on the aﬀected extremity. This finding may indicate compromised circulation, which is

a serious complication that requires immediate intervention.

Option a. Ecchymosis on the inner left thigh may be a concerning finding, but it is not as urgent as diminished pulses. Ecchymosis may be a result of trauma during cast application, and may resolve on its own.

Option b. One fingerbreadth of space between the cast and the skin is a normal finding and indicates that the cast is not too tight.

Option d. Client report of muscle spasms of the left leg is a common complaint in clients with casts and may

be addressed with medication or other interventions, but it is not as urgent as diminished pulses. Therefore, the priority finding in this scenario is c. Diminished pulses on the aﬀected extremity.

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Free Nursing Study Resources

Correct Answer is A

Explanation

Candidiasis, also known as a yeast infection, commonly presents with symptoms such as a thick, white vaginal discharge. It may also be accompanied by itching, redness, and irritation in the vaginal area. This type of discharge is typically described as resembling cottage cheese in texture. Other symptoms that may occur with candidiasis include burning during urination and discomfort during sexual intercourse.

A hard, painless chancre is a characteristic finding of syphilis, not candidiasis. Frothy, malodorous discharge is commonly associated with bacterial vaginosis, not candidiasis.

Feeling of pelvic heaviness is more commonly associated with conditions like pelvic organ prolapse or uterine fibroids, and is not specific to candidiasis.

A. Oﬀer the child sips of clear ﬂuids. B. Place the child in a supine position. C. Administer an oral antiepileptic medication. D. Check the child for oral injuries.

Correct Answer is D

Explanation

After a tonic-clonic seizure, the nurse should first check the child for any injuries, particularly in the oral cavity. This is because during a seizure, the child's tongue may have been biten, or there may be other oral injuries. Therefore, it is essential to check the oral cavity for any injury or bleeding.

Oﬀering sips of clear ﬂuids is not a priority at this time as the child may still be disoriented and at risk of choking. Placing the child in a supine position is also not recommended because the child may have difficulty breathing due to muscle weakness or constriction of the airways. Administering an oral antiepileptic medication is not appropriate at this time unless prescribed by a healthcare provider.

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A nurse is collecting data from a client who has a long leg cast on his left leg. Which of the following findings is the priority?

Nursing Test Bank

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