the client with systemic sclerosis scleroderma is experiencing raynauds phenomenon what assessment finding does the nurse anticipate
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Nursing Elites

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. The client with systemic sclerosis (Scleroderma) is experiencing Raynaud's phenomenon. What assessment finding does the nurse anticipate?

Correct answer: D

Rationale:

2. A post-operative client with a sutured abdominal incision felt a sharp abdominal pain after having a bowel movement. Upon inspection, the nurse notices bowel protruding from the incision site. What does the nurse tell the physician about the event?

Correct answer: A

Rationale:

3. A client is in the emergency room in critical condition and hypotensive. Her spouse is distraught. What is the priority nursing action?

Correct answer: A

Rationale:

4. What nursing intervention is appropriate for a client with systemic lupus erythematous (SLE)?

Correct answer: C

Rationale:

5. What is the priority nursing diagnosis for a client with metastatic bone disease?

Correct answer: C

Rationale: The correct answer is 'Risk for falls.' In clients with metastatic bone disease, weakened bones can lead to an increased risk of falls, making it a priority nursing diagnosis. Chronic pain (choice A) may be present but addressing the risk for falls is more critical in this situation. While impaired mobility (choice B) can be a consequence of metastatic bone disease, preventing falls takes precedence. Risk for infection (choice D) is not the priority in this case, as falls pose a more immediate threat to the client's safety.

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