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 C
Explanation
Choice A Reason:
Instructing the client to tilt their head back to facilitate swallowing is not appropriate. Tilting the head back can increase the risk of aspiration (food or liquid entering the airway) for individuals with dysphagia. Instead, the client should maintain an upright position while eating.
Choice B Reason:
Encouraging the client to use a straw is inappropriate. Using a straw might increase the risk of aspiration because it can bypass the control mechanisms involved in safe swallowing, especially for someone with swallowing difficulties.
Choice C Reason:
Providing oral care before meals is correct. Providing oral care before meals helps to ensure that the client's mouth is clean, reducing the risk of infections and improving taste perception, which can enhance the client's willingness and ability to eat.
Choice D Reason:
Schedule physical therapy directly before meals is incorrect. Scheduling physical therapy directly before meals might tire the client and impact their ability to eat. Fatigue can negatively affect swallowing ability, so it's generally better to allow some rest or recovery time before meals.
Correct Answer is A
Explanation
Choice A Reason;
"You should consume small, frequent meals each day." This statement is advisable for COPD management. Eating smaller, more frequent meals can help prevent bloating or feeling overly full, which might interfere with breathing due to increased pressure on the diaphragm.
Choice B Reason:
"You should decrease your caloric intake by 200 calories per day." While maintaining a healthy weight is important for COPD management, reducing caloric intake without specific guidance or assessment might not be suitable. It's crucial to consult with a healthcare provider or dietitian for individualized dietary recommendations.
Choice C Reason:
"You should increase your oxygen to 5 liters per minute if you have shortness of breath." Adjusting oxygen flow should be done based on a healthcare provider's prescribed guidelines. Self-adjustment of oxygen flow without medical advice can be risky and might not address the underlying cause of shortness of breath during a COPD exacerbation.
Choice D Reason:
"You should discontinue your prednisone when your symptoms improve." Prednisone or other corticosteroids are often prescribed during a COPD exacerbation to reduce inflammation in the airways. However, discontinuing corticosteroids abruptly without a healthcare provider's guidance can lead to a recurrence of symptoms or potential complications. It's important to follow the prescribed regimen and complete the course as directed.
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