Cellulitis of the right lower extremity may present with which assessment finding?

Paresthesia of the right lower extremity

Delayed capillary refill time

Pallor of the right toes

Hot, tender edematous area

Answer and Explanation

The Correct Answer is D

A.   Paresthesia (numbness or tingling) is not a typical finding in cellulitis and may suggest nerve involvement or other conditions.
B.   Delayed capillary refill time would indicate poor circulation or possible shock but is not a direct sign of cellulitis.
C.   Pallor of the right toes could suggest circulatory issues but is not associated with cellulitis.
D.   Cellulitis is an infection of the skin and underlying tissues, usually presenting with warmth (hot), tenderness, redness, and swelling (edema) at the site of infection.

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Correct Answer is D

Explanation

A. The BP must be lower than 180/105 mm Hg to receive fibrinolytic agents, not 130/70 mm Hg.
B. Elevated BPs are common immediately after a stroke, but drug therapy to lower BP is not initiated unless it reaches high levels (typically > 220/120 mm Hg).
C. A lower BP does not act as a protective response; maintaining a higher BP can be necessary initially after a stroke to ensure adequate cerebral perfusion.

D. If BP is 220/120 mm Hg or higher after ischemic stroke, aggressive antihypertensive therapy is initiated to reduce the risk of hemorrhagic transformation and other complications.

A. CNV B. CN VIII C. CN IV D. CN III

Correct Answer is D

Explanation

A. CN V (Trigeminal nerve) is responsible for sensation in the face and motor function for chewing, not eye movement or pupil constriction.
B. CN VIII (Vestibulocochlear nerve) deals with hearing and balance, not eye function.
C. CN IV (Trochlear nerve) controls eye movement, but it does not typically affect the pupil in this way.
D. Cranial nerve III (Oculomotor nerve) controls most eye movements and pupil constriction. A fixed and dilated pupil typically indicates damage to CN III, which may be due to nerve compression, often from increased intracranial pressure or herniation.

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Cellulitis of the right lower extremity may present with which assessment finding?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which statement is accurate about the recommendations for BP management after an ischemic stroke?

Correct Answer is D

Explanation

A nurse observes a patient whose right eye is fixed and dilated, for which cranial nerve (CN) would the nurse suspect nerve compression?

Correct Answer is D

Explanation

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