A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. The initial action by the nurse should be to

Correct Answer: C

Rationale: The correct initial action by the nurse in this scenario is to assess the pedal pulses (Choice C). This is crucial to determine the circulation and perfusion status of the injured limb. If the pedal pulses are absent or weak, it indicates compromised blood flow, which is a medical emergency requiring immediate intervention. Elevating the right leg (Choice A) may worsen circulation if pulses are weak. Splinting the lower leg (Choice B) should only be done after assessing the pulses. Verifying tetanus immunization (Choice D) is important but not the immediate priority in this situation.

Correct Answer: A

Rationale: The correct answer is A: Logroll the patient every 2 hours. This is crucial for a patient with muscular dystrophy due to their weakened muscles, which can lead to pressure ulcers if not repositioned regularly. Logrolling helps prevent skin breakdown and maintains proper body alignment. Incorrect choices: B: Assisting with ambulation is not appropriate for a patient with muscular dystrophy as they have muscle weakness and mobility limitations. C: Discussing genetic testing may be important for diagnosis but is not a priority during hospitalization for pneumonia. D: Teaching about muscle biopsy is not directly related to the immediate care needs of a patient with pneumonia and muscular dystrophy.

Correct Answer: C

Rationale: The correct action before administering gentamicin for a patient with acute osteomyelitis is to review the patient’s serum creatinine (Choice C). This is crucial because gentamicin is nephrotoxic, and assessing the patient's renal function helps to prevent kidney damage. Checking for serum creatinine levels allows the nurse to determine if the patient's kidneys can safely metabolize and excrete the medication without causing harm. Choice A (Ask the patient about any nausea) is not directly related to the safe administration of gentamicin for osteomyelitis. Choice B (Obtain the patient’s oral temperature) is important for monitoring infection but is not specifically required before administering gentamicin. Choice D (Change the prescribed wet-to-dry dressing) is unrelated to medication administration and wound care.

Correct Answer: D

Rationale: The correct answer is D because LPN/LVNs are not typically trained to explain medical tests to patients. LPN/LVNs can administer patch testing, interview patients, and apply sterile dressings under the supervision of a healthcare provider. Explaining medical tests requires a higher level of knowledge and skill, usually performed by registered nurses or healthcare providers. Therefore, delegating the task of explaining potassium hydroxide testing to an LPN/LVN would not be within their scope of practice.

Correct Answer: C

Rationale: The correct answer is C: Edema of the eyelids. This is correct because rosacea can sometimes lead to ocular complications, such as blepharitis, conjunctivitis, and edema of the eyelids. These conditions can affect the eyes of individuals with rosacea. Rationale: - A: Inflamed and tender axillary lymph nodes are not typically associated with rosacea. This is an incorrect choice. - B: While eye problems are a potential complication of rosacea, edema of the eyelids is a more specific and direct complication that should be assessed for. - D: Large abscesses on the upper arms and neck are not commonly associated with rosacea. This choice is incorrect.