A nurse working in an emergency department is caring for a client who has third-degree frostbite to both lower extremities. The nurse should take which of the following actions?

Massage the legs.

Apply dry heat to the legs.

Elevate the legs.

Immerse the legs in cold water.

Answer and Explanation

The Correct Answer is C

A. Massage the legs: This is incorrect. Massage is contraindicated as it can cause further tissue damage and is not appropriate for frostbite.
B. Apply dry heat to the legs: This is incorrect. Dry heat can exacerbate tissue damage. Rewarming should be done using controlled, warm water immersion, not dry heat.
C. Elevate the legs: This is correct. Elevating the legs helps reduce swelling and can prevent further tissue damage. However, rewarming should be done carefully in a controlled environment.
D. Immerse the legs in cold water: This is incorrect. Immersing in cold water would worsen the frostbite. Rewarming should be done using warm (not hot) water, ideally at 37-39°C (98.6-102.2°F), for effective treatment.

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Correct Answer is B

Explanation

A. A client who has an open upper extremity fracture: While this is a serious injury, it is less critical compared to a tension pneumothorax in a triage setting.
B. A client experiencing a tension pneumothorax: This is a life-threatening condition that requires immediate intervention to relieve pressure on the lungs and restore adequate breathing.
C. A client who has full-thickness burns over 85% of their body: This is a severe condition with a high mortality risk, but in a mass casualty situation, a tension pneumothorax is prioritized for immediate care.
D. A client who has agonal respirations: Agonal respirations indicate severe distress, but the immediate need for intervention is to address conditions that can rapidly compromise life, such as a tension pneumothorax.

A. A history of pelvic inflammatory disease (PID) B. Abdominal bloating starting several days before menses C. Dysmenorrhea that is unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs) D. An atypical Papanicolaou (Pap) smear at her last clinic visit

Correct Answer is C

Explanation

A. A history of pelvic inflammatory disease (PID): While PID can cause pelvic pain, it is not specifically indicative of endometriosis. Endometriosis is a distinct condition with its own set of symptoms.
B. Abdominal bloating starting several days before menses: This symptom can occur with endometriosis, but it is not as specific as other symptoms.
C. Dysmenorrhea that is unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs): Endometriosis often presents with severe dysmenorrhea that does not respond well to NSAIDs. This is a classic symptom of endometriosis.
D. An atypical Papanicolaou (Pap) smear at her last clinic visit: An atypical Pap smear is more related to cervical abnormalities and is not a specific finding for endometriosis.

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A nurse working in an emergency department is caring for a client who has third-degree frostbite to both lower extremities. The nurse should take which of the following actions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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