Exhibits
Specify which potential condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s response.
The Correct Answer is []
- The client is most likely experiencing compartment syndrome, which is a condition where increased pressure within a closed space compromises blood flow and tissue perfusion. Compartment syndrome can occur after a fracture, especially if a cast or splint is applied too tightly. Some of the signs and symptoms of compartment syndrome are severe pain, paresthesia, pallor, and pulselessness.
- Two actions the nurse should take to address compartment syndrome are:
- Elevate the extremity above the level of the heart to reduce swelling and improve venous return.
- Remove the cast or loosen the dressing to relieve the pressure and restore blood flow. This may require notifying the physician or obtaining an order for bivalving or cutting the cast.
- Two parameters the nurse should monitor to assess the client’s condition are:
- Capillary refill of the affected fingers, which should be less than 3 seconds. A prolonged capillary refill indicates poor perfusion and tissue ischemia.
- Blood pressure of the client, which should be maintained within normal limits. Hypotension can worsen the perfusion deficit and lead to tissue necrosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B", "C","D"]
Explanation
- Choice A: Occupational therapist. This is correct because an occupational therapist can help the client with activities of daily living (ADLs) such as dressing, grooming, eating, and toileting. The client may have difficulty performing these tasks due to the facial droop and weakness caused by the stroke.
- Choice B: Speech therapist. This is correct because a speech therapist can help the client with communication and swallowing problems. The client has garbled speech, which indicates a possible aphasia or dysarthria. The client may also have dysphagia, which is difficulty swallowing, due to the impaired coordination of the muscles involved in swallowing.
- Choice C: Case manager. This is correct because a case manager can coordinate the client's care and discharge planning. The case manager can arrange for referrals, home health services, equipment, and follow-up appointments as needed. The case manager can also provide education and support to the client and family.
- Choice D: Physical therapist. This is correct because a physical therapist can help the client with mobility and balance issues. The client may have hemiparesis or hemiplegia, which is weakness or paralysis of one side of the body. The physical therapist can assist the client with exercises, gait training, and assistive devices to improve the client's functional status.
- Choice E: Chief nursing officer. This is incorrect because a chief nursing officer is not directly involved in the client's recovery. A chief nursing officer is a senior-level executive who oversees the nursing staff and operations of a health care organization. A chief nursing officer may have a role in quality improvement, policy development, and strategic planning, but not in individual client care.
- Choice F: Pharmacy technician. This is incorrect because a pharmacy technician is not directly involved in the client's recovery. A pharmacy technician is a health care professional who assists pharmacists with dispensing medications and other tasks. A pharmacy technician may have a role in preparing, labeling, and delivering medications, but not in providing therapy or education to the client.
- Choice G: Respiratory therapist. This is incorrect because a respiratory therapist is not directly involved in the client's recovery. A respiratory therapist is a health care professional who provides respiratory care to patients with breathing problems. A respiratory therapist may have a role in administering oxygen, nebulizers, ventilators, and other respiratory treatments, but not in addressing the client's stroke-related impairments.
- Choice H: Medical assistant. This is incorrect because a medical assistant is not directly involved in the client's recovery. A medical assistant is a health care professional who performs administrative and clinical tasks in a medical office or clinic. A medical assistant may have a role in scheduling appointments, taking vital signs, drawing blood, and performing basic laboratory tests, but not in providing rehabilitation or education to the client.
Correct Answer is D
Explanation
Choice A reason: This is incorrect because consuming a high protein diet is not a recommended strategy to reduce risk factors for BPH. In fact, some studies have suggested that a high protein intake may increase the risk of BPH by stimulating the production of insulin-like growth factor-1 (IGF-1), which may promote prostate growth.
Choice B reason: This is incorrect because obtaining a prostate-specific antigen blood level test is not a preventive measure for BPH, but rather a diagnostic tool to detect prostate cancer or monitor its treatment. Prostate-specific antigen (PSA) is a protein produced by the prostate gland that can be elevated in both BPH and prostate cancer. However, PSA levels alone cannot distinguish between these two conditions and need to be interpreted along with other factors, such as age, race, family history, and digital rectal examination.
Choice C reason: This is incorrect because taking vitamin supplements is not a proven method to reduce risk factors for BPH. While some vitamins, such as vitamin D and vitamin E, may have some beneficial effects on prostate health, there is not enough evidence to support their use as preventive agents for BPH. Moreover, some vitamins, such as vitamin A and vitamin B6, may have adverse effects on prostate health and increase the risk of BPH or prostate cancer.
Choice D reason: This is correct because increasing physical activity is a helpful way to reduce risk factors for BPH. Physical activity can help maintain a healthy weight, lower blood pressure, improve blood circulation, reduce inflammation, and regulate hormone levels. All of these factors can contribute to preventing or delaying the development of BPH.
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