A client presents the emergency department with a Grade II ankle sprain. Which of the following interventions should the nurse implement?
Encourage the client to walk on the injured ankle to promote circulation.
Immerse the ankle in want water immediately after the in
Apply ice to the affected ankle for the first 24-72 hours.
Perform deep tissue massage on the injured area to reduce pain.
The Correct Answer is C
A. Encourage the client to walk on the injured ankle to promote circulation. Weight-bearing activities should be avoided initially after a Grade II sprain to prevent further injury.
B. Immerse the ankle in warm water immediately after the injury. Ice, rather than warmth, is recommended immediately following an injury to reduce swelling and inflammation.
C. Apply ice to the affected ankle for the first 24-72 hours. Applying ice for 24-72 hours helps reduce swelling and pain by causing vasoconstriction and controlling inflammation in the acute phase.
D. Perform deep tissue massage on the injured area to reduce pain. Massaging a newly sprained ankle can aggravate inflammation and cause additional tissue damage.
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Correct Answer is ["B","C","D"]
Explanation
A. Obese extremities. Clients with Cushing's syndrome typically experience central (truncal) obesity with thin extremities due to fat redistribution and muscle wasting, not obese extremities.
B. Buffalo hump: A "buffalo hump" (fat pad on the back of the neck) is a common characteristic of Cushing's syndrome due to abnormal fat distribution.
C. Purple striations. Purple or reddish striae on the abdomen and other areas are commonly seen in Cushing's syndrome due to skin thinning and collagen breakdown.
D. Moon face. A round, full face (moon face) is a classic sign of Cushing's syndrome due to fat deposits in the face.
E. Tremors. Tremors are not typically associated with Cushing's syndrome and are more often associated with neurological or metabolic conditions.
Correct Answer is A
Explanation
A. Stroke: The sudden onset of one-sided weakness, numbness, difficulty speaking, and severe headache are classic symptoms of an acute stroke, where blood flow to part of the brain is interrupted, leading to neurological deficits.
B. Migraine: While migraines can cause headache and some neurological symptoms, they usually include visual disturbances, nausea, or photophobia rather than one-sided weakness and numbness.
C. Hypoglycemia: Hypoglycemia can cause confusion, weakness, and headache, but it typically lacks the focal neurological symptoms, like one-sided weakness and numbness.
D. Transient Ischemic Attack (TIA): A TIA can cause similar symptoms, but the deficits are usually transient and resolve within 24 hours without lasting neurological damage. Persistent symptoms are more indicative of a stroke.