A nurse is collecting data from a client who requires bed rest and has developed thrombophlebitis. Which of the following findings should the nurse expect when examining the client's leg?
Cool skin
Numbness
Edema
Pallor
The Correct Answer is C
A. Cool skin: Cool skin is not typically associated with thrombophlebitis. It is more common with arterial issues rather than venous problems.
B. Numbness: Numbness is generally a sign of nerve involvement or arterial occlusion, not a classic finding of thrombophlebitis, which primarily affects veins.
C. Edema: Edema is a common finding with thrombophlebitis due to venous inflammation and obstruction of blood flow, which leads to fluid accumulation in the affected limb.
D. Pallor: Pallor is more commonly associated with arterial insufficiency rather than venous issues like thrombophlebitis. Thrombophlebitis often presents with redness and warmth instead of pallor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. The QT interval is equal to the R to R interval. This is not a finding associated with myocardial infarction. QT interval changes are more related to electrolyte imbalances or medication effects.
B. The QRS intervals are 0.08 second. A QRS duration of 0.08 seconds is normal and does not indicate myocardial infarction. Prolongation of the QRS complex might suggest a bundle branch block or other conduction issues.
C. The ST segment is above the isoelectric line. ST-segment elevation is a hallmark sign of an acute myocardial infarction (STEMI). It reflects injury to the heart muscle.
D. The PR intervals are 0.15 second. A PR interval of 0.15 seconds is within the normal range (0.12–0.20 seconds) and does not indicate myocardial infarction.
Correct Answer is A
Explanation
A. "Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart." Nitroglycerin works by dilating the coronary arteries, increasing blood flow and oxygen delivery to the heart muscle, thereby reducing angina.
B. "Nitroglycerin relieves nausea and prevents vomiting, which could lead to aspiration." Nitroglycerin does not have an antiemetic function or impact nausea and vomiting.
C. "Nitroglycerin acts as a bronchodilator to open small airways and decrease shortness of breath." Nitroglycerin is not a bronchodilator. It does not act on the airways but instead works on blood vessels.
D. "Nitroglycerin decreases chest pain by dissolving blood clots that are occluding the arteries." Nitroglycerin does not dissolve blood clots. Thrombolytic agents are used for clot dissolution, not nitroglycerin.
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