A nurse is providing teaching to a client who has a prescription for heat therapy for treatment of cellulitis of the right lower leg. Which of the following client statements indicates an understanding of the teaching?
"I'll keep a heating pad on the calf of my right leg when I am lying down."
"I'll wrap a warm, wet towel around my right calf every 4 hours."
"I'll place my leg under a heat lamp every 3 hours."
"I will sit on the side of the tub and soak my right leg two times every day."
The Correct Answer is B
Rationale:
A. Keeping a heating pad on the leg for extended periods can lead to burns or skin damage. Heat therapy should be applied intermittently with breaks to prevent overheating.
B. Wrapping a warm, wet towel and applying it intermittently is appropriate for localized heat therapy and can help reduce inflammation and promote healing.
C. Using a heat lamp may not provide consistent or controlled heat application and is not the standard approach for treating cellulitis.
D. Soaking the leg in a tub is not recommended as it may introduce bacteria and potentially worsen the infection.
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Correct Answer is C
Explanation
Rationale:
A. Observing the final 2 minutes is not sufficient for detecting acute transfusion reactions, which can occur at any time during the transfusion.
B. Observing the final 15 minutes is also not adequate; reactions can occur earlier.
C. The first 15 minutes is the most critical time for observing for transfusion reactions, as most reactions occur during this period.
D. The first 2 minutes are too brief to detect potential transfusion reactions, which typically manifest within the first 15 minutes.
Correct Answer is D
Explanation
Rationale:
A. Seizures and tremors can occur with some antipsychotic medications but are not specifically indicative of tardive dyskinesia.
B. Hallucinations and delusions are symptoms of psychosis, not a side effect of anti-psychotic medications.
C. Nausea and vomiting can be side effects of anti-psychotic medications but are not characteristic of tardive dyskinesia.
D. Tardive dyskinesia is characterized by uncontrolled, repetitive movements, such as facial grimacing, tongue protrusion, and other involuntary movements.