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    ATI ns 550 Fundamentals proctored Exam

    The nurse is caring for a patient with swelling and redness following an ankle sprain. Which action by the nurse is most appropriate?

    Explanation & Rationale

    Choice A reason: Applying a warm compress may increase swelling by promoting blood flow, which is contraindicated in acute sprains. Elevation reduces edema by gravity-assisted drainage, making warm compresses less appropriate for initial sprain management. Choice B reason: Elevating the ankle above heart level is the most appropriate action, as it reduces swelling and redness by promoting venous and lymphatic drainage. This aligns with RICE (rest, ice, compression, elevation) protocol, making it the primary intervention for an acute sprain. Choice C reason: Encouraging weight-bearing exercises is inappropriate for an acute sprain, as it may worsen injury and swelling. Rest and elevation are needed initially, with exercises introduced later in recovery, making this an incorrect action. Choice D reason: Wrapping the ankle provides compression, which is helpful, but elevation more directly reduces swelling in the acute phase. Compression is a secondary RICE component, making elevation the priority for immediate swelling control in a sprain.

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