The nurse assessing a client's intravenous catheter site suspects a phlebitis based on which clinical findings?
Warmth and palpable cord along the vein
A raised ecchymotic painful area
Swelling and tenderness at the site
Blanching and coolness of surrounding skin
The Correct Answer is A
A. These are indicative of inflammation within the vein, which is characteristic of phlebitis. Warmth is a common sign of inflammation, and the palpable cord suggests that the vein may be hardened or cord- like due to inflammation and irritation.
B. While this could indicate some form of vascular injury or extravasation, it is not a typical presentation of phlebitis. Phlebitis involves inflammation of the vein, which may cause redness, warmth, and tenderness along the course of the vein, but it typically does not manifest as a raised ecchymotic (bruised) area.
C. Swelling occurs due to inflammation within the vein, and tenderness is often present as a result of the irritation and inflammation. These symptoms are commonly observed in cases of phlebitis but are not specific.
D. These are not typical signs of phlebitis. Blanching (turning white) and coolness of the skin may suggest reduced blood flow to the area, which could occur in cases of ischemia or thrombosis but are not characteristic of phlebitis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. One of the primary purposes of inserting an NG tube is to decompress the stomach by removing gastric contents. In the case of abdominal distention and severe vomiting, excess gas and fluid accumulation in the stomach can contribute to discomfort and further vomiting. The NG tube provides a way to suction out these contents, relieving pressure and reducing symptoms.
B. NG tubes can also be used to administer medications directly into the stomach. This route is particularly useful when a client is unable to take medications orally due to vomiting or other gastrointestinal issues. Medications can be crushed and dissolved in liquid form before being administered through the NG tube.
C. In some situations, such as when assessing for gastrointestinal bleeding or checking for tube placement, it may be necessary to determine the pH of gastric secretions. Gastric aspirate obtained through the NG tube can be tested for acidity, which can help confirm that the tube is correctly positioned in the stomach and provide information about the client's digestive function.
D. While NG tubes can be used to supply nutrients via tube feedings, this is not typically the primary rationale for their use in the acute situation described (abdominal distention and severe vomiting). However, in cases where a client is unable to tolerate oral intake due to their condition, tube feedings can be administered through the NG tube to provide essential nutrients and maintain nutritional status.
Correct Answer is ["A","B","C","D","E"]
Explanation
A. The health status prior to the accident can influence how individuals respond to stress. Clients with pre-existing medical conditions, chronic pain, or disabilities may experience increased stress due to concerns about exacerbation of their conditions, recovery, or long-term consequences. Therefore, health status prior to the accident can impact the degree of stress experienced.
B. Age can influence individuals' coping mechanisms and resilience in response to stress. Younger individuals may have less life experience and coping skills, while older individuals may have accumulated more experience and developed better coping strategies over time. Additionally, age-related factors such as physical resilience and social support networks can affect how individuals respond to stressors. Therefore, different ages can influence the degree of stress experienced.
C. External resources such as social support networks, access to healthcare, financial stability, and community resources can significantly impact individuals' ability to cope with stress. Clients with strong support systems, adequate access to medical care, and financial security may experience lower levels of stress compared to those lacking these resources. Therefore, external resources can influence the degree of stress experienced.
D. Individual problem-solving skills play a crucial role in how individuals perceive and manage stressful situations. Clients with strong problem-solving skills may feel more confident in their ability to address challenges and may experience lower levels of stress. Conversely, clients with limited problem-solving skills may feel overwhelmed and experience higher levels of stress. Therefore, individual problem- solving skills can influence the degree of stress experienced.
E. Personality traits such as resilience, optimism, neuroticism, and coping styles can impact how individuals respond to stressors. For example, individuals with resilient personalities and positive coping styles may adapt more effectively to stressors and experience lower levels of stress. Conversely, individuals with neurotic personalities or maladaptive coping styles may be more prone to experiencing heightened stress levels. Therefore, personalities can influence the degree of stress experienced.
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