The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching?

"Put an ice pack on the ankle, alternating 20 minutes on with 20 minutes off."

"Wrap the ankle in an Ace bandage for support."

"Keep the leg elevated when sitting"

"Apply warm compresses to the ankle for the first 24 hours."

Answer and Explanation

The Correct Answer is D

D. Warm compresses or heat therapy are not recommended for the initial management of a sprained ankle, especially within the first 24 hours. Heat can increase blood flow and exacerbate swelling and inflammation, which may worsen pain and delay healing.

A. Applying ice packs in this manner helps reduce inflammation and swelling, which are common after a sprain. Alternating ice application with periods of rest allows for effective cooling without causing tissue damage.

B. Wrapping the ankle in an Ace bandage can provide compression and support, which may help reduce swelling and stabilize the joint during the healing process. However, it's important not to wrap the bandage too tightly, as this can impair circulation.

C. Elevating the leg when sitting helps reduce swelling by promoting venous return and preventing fluid accumulation in the injured area. Keeping the ankle elevated above the level of the heart whenever possible is recommended for optimal swelling reduction.

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Correct Answer is A

Explanation

A. Wheezing, which is a high-pitched whistling sound heard during expiration, is a common symptom of asthma. It occurs due to narrowed airways and airflow obstruction, often in response to triggers such as allergens, respiratory infections, or exercise.

B. Low-grade fever in the afternoon is not typically associated with asthma. Fever is more commonly seen in response to infections, such as respiratory infections, which can exacerbate asthma symptoms but is not a direct manifestation of asthma itself.

C. Without the complete statement, it is difficult to assess its relevance to asthma symptoms. However, an abrupt onset of symptoms, such as sudden shortness of breath or chest tightness, may occur during an asthma attack or exacerbation.

D. Sharp pleuritic pain is not a typical finding in asthma. Pleuritic pain, which is sharp and worsened by breathing, is more commonly associated with conditions affecting the pleura, such as pneumonia or pleurisy.

A. Adduction of the arms at the shoulders B. Abnormal flexion of the upper extremities and extension and adduction of lower extremities C. Flaccid paralysis of all extremities D. Rigid extension and pronation of the arms and legs

Correct Answer is D

Explanation

D. This is the correct characteristic of decerebrate posturing. Decerebrate posturing is characterized by rigid extension and pronation (turning inward) of the arms and legs. It indicates severe neurological dysfunction and increased intracranial pressure, often involving damage to the brainstem.

A. This characteristic is not associated with decerebrate posturing. Adduction refers to movement toward the midline of the body, which is not typically observed in decerebrate posturing.

B. This description is not characteristic of decerebrate posturing. Decerebrate posturing involves extension, not flexion, of the upper extremities, along with extension and pronation (not adduction) of the lower extremities.

C. Flaccid paralysis refers to the absence of muscle tone and movement, which is not characteristic of decerebrate posturing. Decerebrate posturing involves increased muscle tone and abnormal, rigid extension of the arms and legs.

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The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a school-age child who has asthma. The nurse should identify which of the following findings?

Correct Answer is A

Explanation

The nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristic of this type of posturing?

Correct Answer is D

Explanation

The nurse notes documentation that a child with meningitis is exhibiting a positive Kernig's sign. Which observation is a characteristic of this sign?

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