A nurse is reinforcing teaching with a client who has a grade 2 ankle sprain. Which of the following statements by the client indicates an understanding of the teaching?
"I will apply heat to my affected ankle to decrease swelling."
"I can bear full weight on my affected ankle."
"I can dangle my affected ankle from the edge of the bed."
"I will wrap my affected ankle with an elastic bandage."
The Correct Answer is D
Choice A Reason:
"I will apply heat to my affected ankle to decrease swelling." Heat application is generally not recommended for acute injuries like ankle sprains. Heat can increase blood flow and potentially worsen swelling. Cold therapy (like ice) is typically advised in the early stages to reduce inflammation and swelling.
Choice B Reason:
"I can bear full weight on my affected ankle." For a grade 2 ankle sprain, bearing full weight on the affected ankle might not be advisable initially. Grade 2 sprains involve partial tearing of ligaments and usually require some period of rest or limited weight-bearing to allow healing.
Choice C Reason:
"I can dangle my affected ankle from the edge of the bed. “Dangling the affected ankle from the edge of the bed is a common recommendation to help with gentle movement and improve blood flow without putting excessive stress on the injured ankle. This activity can aid in the recovery process and is often recommended.
Choice D Reason:
"I will wrap my affected ankle with an elastic bandage. “Wrapping the affected ankle with an elastic bandage is a supportive measure recommended for managing ankle sprains. It helps provide compression, support, and stabilization to the injured area, assisting in reducing swelling and providing comfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
"I will perform breast exams the day my period begins." This statement is incorrect because performing breast exams just before or during your period might not be ideal. Breasts can be more tender or swollen during this time, which could make it harder to detect any abnormalities.
Choice B Reason:
"I will perform breast exams every other month." This statement is incorrect. Regular breast self-exams are important, but doing them every other month might not be frequent enough. It's generally recommended to perform breast self-exams once a month, ideally around the same time each month, to detect any changes or abnormalities early.
Choice C Reason:
"It is common for the skin on my breasts to dimple." This statement is incorrect. Dimpling or puckering of the skin on the breasts can sometimes be a sign of an underlying issue, such as breast cancer. It's not considered a normal or common occurrence, so this statement doesn't indicate an understanding of what to look for during a breast self-exam. If a person notices skin changes like dimpling, it's recommended to seek medical advice.
Choice D Reason:
"It is common for one breast to be larger than the other." This statement reflects an understanding that breast asymmetry, where one breast is slightly larger than the other, is a common and normal occurrence.
Correct Answer is A
Explanation
Choice A Reason:
Suction equipment is recommended. This is a crucial supply to have at hand. During or after a seizure, the client might have excessive secretions or vomit, which could potentially obstruct their airway. Suction equipment helps clear the airway and maintain breathing, making it an essential item to have bedside.
Choice B Reason:
Padded tongue blades is incorrect. The use of padded tongue blades during a seizure is not recommended. Placing anything inside the mouth during a seizure could cause injury or pose a risk of choking. Keeping the airway clear and ensuring the client's safety is more important than attempting to manipulate the tongue.
Choice C Reason:
Backboard is incorrect.Backboards are typically used for spinal immobilization in cases of suspected spinal injury, not specifically for seizure management. Unless there's a concurrent injury or trauma, a backboard wouldn't be routinely necessary for a client having a seizure.
Choice D Reason:
Wrist restraints is incorrect. Restraints are generally not used for managing seizures. Using restraints during a seizure could potentially cause harm, restrict movement, and increase the risk of injury to the client. Restraints are not considered appropriate or safe for managing seizures.

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