The nurse is reinforcing teaching provided to a patient with Raynaud's disease. Which measure should the nurse include to prevent an attack?
Get plenty of outdoor exercise all year.
Keep affected body areas covered at all times.
Take vasopressors to prevent exacerbation of symptoms.
Avoid stimulation that causes vasoconstriction.
The Correct Answer is D
Choice A reason: Getting plenty of outdoor exercise all year is beneficial for overall health but does not specifically prevent Raynaud's attacks, especially in cold weather.
Choice B reason: Keeping affected body areas covered, especially in cold weather, helps prevent Raynaud's attacks by maintaining warmth.
Choice C reason: Taking vasopressors is not a measure to prevent Raynaud's attacks; vasopressors could potentially worsen the condition by causing further vasoconstriction.
Choice D reason: Avoiding stimulation that causes vasoconstriction, such as stress and cold temperatures, is key to preventing Raynaud's attacks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Notifying the registered nurse is important but should come after initially assessing the patient's immediate needs.
Choice B reason: Raising the head of the bed may help with breathing but does not address the cause of the patient's distress.
Choice C reason: Sitting with her and listening to her concerns is supportive but should follow an initial assessment of why she is sobbing and gasping for breath.
Choice D reason: Asking the patient what is wrong is the first step in assessing the situation and providing appropriate care.
Correct Answer is D
Explanation
Choice A reason: Fecal impaction typically presents with the inability to pass stool and may not be associated with the absence of bowel sounds.
Choice B reason: Incisional infection is usually indicated by localized redness, warmth, and possible discharge, not necessarily by the absence of bowel sounds or flatus.
Choice C reason: Health care-associated Clostridium difficile often presents with diarrhea, not the absence of bowel sounds or flatus.
Choice D reason: Paralytic ileus is characterized by impaired intestinal motility and transit, absence of the passage of flatus, diminished bowel sounds, abdominal distension, and intestinal dilatation, fitting the symptoms described.

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