Author Question: A nurse has assessed a patient's capillary refill, which was 5 seconds. What action by the nurse is ... (Read 113 times)

fnuegbu · **on:** Jul 23, 2018

A nurse has assessed a patient's capillary refill, which was 5 seconds. What action by the nurse is most appropriate?

a. Document the findings and continue the examination.
b. Ask the patient about the use of artificial nails.
c. Ask the patient about his/her occupation.
d. Assess the patient for signs of hypoxia.

Question 2

The nurse is planning to educate four patients on preventing skin cancer and early warning signs. Which patient is the priority for this education?

a. Adolescent who uses a tanning bed
b. Middle-aged adult who walks for fitness
c. Older woman who sits in the sun for 10 minutes daily
d. Person who works indoors under fluorescent lights

blazinlyss · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: D
Normal capillary refill is 2 to 3 seconds. Prolonged capillary refill can indicate hypoxia, anemia, or circulatory insufficiency. The nurse should document the findings, but further action is not needed. Asking about artificial nails and occupation are not warranted.

Answer to Question 2

ANS: A
Research indicates that indoor tanning increases the risk of developing skin cancer by 75. The adolescent who tans is the highest priority for this education. The others do not have as high a risk.