A provider prescribes cold application for a client who reports ankle joint stiffness. Which of the following assessment findings should the nurse identify as a contraindication to the application of cold?
2+ pitting edema
7.5 cm (3 in) diameter bruise on the ankle
Capillary refill 4 seconds
Warts on the affected ankle
The Correct Answer is C
A. 2+ pitting edema is not a contraindication to cold application; in fact, cold application can help reduce edema.
B. A 7.5 cm (3 in) diameter bruise on the ankle is not a contraindication to cold application; cold can help reduce swelling and alleviate pain.
C. Capillary refill of 4 seconds suggests compromised blood flow, and cold application may further impair circulation. It is a contraindication.
D. Warts on the affected ankle are not a contraindication to cold application.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. 1+ pitting edema is mild, with a slight indentation.
B. 4+ pitting edema is severe, with a deep indentation that lasts a long time.
C. 3+ pitting edema is moderate, with a deeper indentation that takes some time to rebound.
D. 2+ pitting edema is moderate, with a slight indentation that rebounds fairly quickly.
Correct Answer is A
Explanation
A. Surveying the target population is the best approach to identify the specific interests and
health concerns of the older adults, ensuring that the programs are relevant and tailored to their needs.
B. Determining the availability of health care providers is a logistical consideration but may not necessarily address the specific interests or needs of the older adults.
C. Basing the programs on their developmental stage is important, but surveying the population allows for a more comprehensive understanding of their diverse needs and preferences.
D. Reviewing Healthy People 2020 Objectives is a valuable resource, but it may not capture the specific interests or concerns of the local population.
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