Nokea
The healthcare provider is assessing a client with Raynaud's phenomenon. Which finding should the healthcare provider expect?
- A. Thickened and hardened skin.
- B. Painless ulcers on the fingertips.
- C. Episodes of cyanosis and pallor in the fingers.
- D. Red, scaly patches on the hands.
Correct Answer: C
Rationale: The correct answer is C: Episodes of cyanosis and pallor in the fingers. Raynaud's phenomenon is characterized by vasospasms of small arteries, leading to reduced blood flow and color changes in the digits. Cyanosis (bluish discoloration) and pallor (pale color) are common during episodes. Thickened and hardened skin (A) is associated with scleroderma. Painless ulcers on the fingertips (B) are seen in advanced stages of systemic sclerosis. Red, scaly patches on the hands (D) are indicative of psoriasis, not Raynaud's phenomenon.
You may also like to solve these questions
A client with coronary artery disease (CAD) is prescribed atorvastatin (Lipitor). Which laboratory value requires immediate intervention?
- A. Total cholesterol of 180 mg/dL.
- B. Low-density lipoprotein (LDL) of 200 mg/dL.
- C. Triglycerides of 150 mg/dL.
- D. High-density lipoprotein (HDL) of 40 mg/dL.
Correct Answer: B
Rationale: The correct answer is B: LDL of 200 mg/dL. Elevated LDL levels are a major risk factor for CAD and require immediate intervention. Atorvastatin (Lipitor) is used to lower LDL levels. High LDL contributes to plaque buildup in arteries.
A: Total cholesterol of 180 mg/dL is within the normal range and doesn't require immediate intervention.
C: Triglycerides of 150 mg/dL are also within the normal range and don't pose an immediate risk.
D: HDL of 40 mg/dL is considered low, but it is not as critical as high LDL levels in the context of CAD.
The client has been prescribed metformin (Glucophage) for type 2 diabetes. Which instruction should the nurse include in discharge teaching?
- A. Take the medication at bedtime.
- B. Take the medication with meals.
- C. Take the medication on an empty stomach.
- D. Take the medication as needed for high blood sugar.
Correct Answer: B
Rationale: The correct answer is B: Take the medication with meals. Metformin is typically taken with meals to minimize gastrointestinal side effects. Food helps in the absorption and tolerance of the medication. Taking it on an empty stomach can lead to stomach upset. Taking it at bedtime may also cause nighttime disruptions. Taking it as needed for high blood sugar is not appropriate as metformin is usually taken regularly to control blood sugar levels.
A client with newly diagnosed diabetes mellitus is receiving teaching on foot care. Which instruction should the nurse include?
- A. Walk barefoot whenever possible to toughen your feet.
- B. Soak your feet in hot water daily to improve circulation.
- C. Trim your toenails straight across to prevent ingrown toenails.
- D. Use a heating pad to keep your feet warm.
Correct Answer: C
Rationale: Correct Answer: C - Trim your toenails straight across to prevent ingrown toenails.
Rationale:
1. Trimming toenails straight across helps prevent ingrown nails.
2. Ingrown nails can lead to infection, especially risky for diabetics due to poor wound healing.
3. Walking barefoot toughens feet, increasing risk of injury.
4. Soaking in hot water can cause burns or skin damage.
5. Using a heating pad can lead to burns or decreased sensation in feet, increasing injury risk.
Summary:
Option C is correct as it directly addresses a common issue in diabetic foot care - ingrown toenails. Options A, B, and D pose risks of injury or damage to the feet, which is detrimental for diabetic individuals.
The nurse is caring for a client with hyperthyroidism. Which intervention should the nurse implement to manage the client's condition?
- A. Provide a high-calorie diet.
- B. Encourage frequent rest periods.
- C. Restrict fluid intake.
- D. Administer a stool softener.
Correct Answer: B
Rationale: The correct answer is B: Encourage frequent rest periods. For a client with hyperthyroidism, rest is crucial to conserve energy and support the body's recovery. Hyperthyroidism is characterized by increased metabolic rate, leading to fatigue and weakness. Rest periods help reduce metabolic demands and prevent exhaustion. A high-calorie diet (choice A) may be necessary to support increased metabolism but is not the priority. Restricting fluid intake (choice C) can lead to dehydration, which should be avoided in hyperthyroidism. Administering a stool softener (choice D) is unrelated to managing hyperthyroidism.
A client with type 1 diabetes mellitus is admitted with hyperglycemia. Which laboratory result requires the most immediate intervention?
- A. Serum glucose of 350 mg/dL.
- B. Serum potassium of 2.8 mEq/L.
- C. Serum sodium of 136 mEq/L.
- D. Serum bicarbonate of 20 mEq/L.
Correct Answer: B
Rationale: The correct answer is B: Serum potassium of 2.8 mEq/L. Hypokalemia can lead to life-threatening cardiac arrhythmias, especially in diabetic patients with hyperglycemia. Immediate intervention is needed to prevent cardiac complications.
A: Serum glucose of 350 mg/dL is high but not immediately life-threatening.
C: Serum sodium of 136 mEq/L is within normal range and does not require immediate intervention.
D: Serum bicarbonate of 20 mEq/L is slightly low but does not pose an immediate risk to the patient's life.