Nokea
A client is in balanced suspension traction using a half-ring Thomas splint with a Pearson attachment that suspends the lower extremity and applies direct skeletal traction for a hip fracture. Which of the following nursing assessments would not be appropriate?
- A. Greater trochanter skin checks.
- B. Pin site inspection.
- C. Neurovascular checks proximal to the splint.
- D. Foot movement evaluation.
Correct Answer: C
Rationale: Neurovascular checks proximal to the splint are less relevant, as distal checks assess circulation and nerve function affected by the fracture and traction.
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The client with an ileal conduit will be using a reusable appliance at home. The nurse should teach the client to clean the appliance routinely with the client to clean the appliance routinely.
- A. Baking soda.
- B. Soap.
- C. Hydrogen peroxide.
- D. Alcohol.
Correct Answer: B
Rationale: Soap is safe and effective for cleaning reusable ileal conduit appliances, removing residue without damaging the appliance or irritating the skin.
The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is performing discharge education for a 31-year-old female client.
Item 1 of 1
Progress Notes Orders
1710: The client has pelvic inflammatory disease and bacterial vaginosis. Will discharge the client home with antibiotics and with the instruction that the client should follow-up with her primary physician in two weeks.
The nurse is teaching a client about their prescribed medications. For each education statement, click to specify if the statement is relevant to metronidazole or doxycycline.
- A. You will need to use a backup method of contraception.
- B. Avoid consuming and using products with alcohol.
- C. You may experience a darkening of your urine.
- D. Do not take this medication with food or drinks containing calcium.
Correct Answer: A,B,C,D
Rationale: A (Doxycycline): Doxycycline can reduce the effectiveness of hormonal contraceptives, requiring a backup method. B (Metronidazole): Alcohol should be avoided with metronidazole due to a disulfiram-like reaction. C (Metronidazole): Darkening of urine is a side effect of metronidazole. D (Doxycycline): Calcium-containing foods/drinks reduce doxycycline absorption.
The nurse is planning care for a client with a fractured humerus in a sling. Which intervention should be included?
- A. Encourage shoulder shrugging exercises.
- B. Apply heat to the fracture site.
- C. Keep the arm in a dependent position.
- D. Restrict all arm movement.
Correct Answer: A
Rationale: Shoulder shrugging exercises maintain mobility and prevent stiffness without stressing the fracture.
The nurse in the intensive care unit is giving a report to the nurse in the post-surgical unit about a client who had a gastrectomy. The most effective way to assure essential information about the client is reported is to:
- A. Give the report face-to-face with both nurses in a quiet room.
- B. Audiotape the report for future reference and documentation.
- C. Use a printed checklist with information individualized for the client.
- D. Document essential transfer information in the client's electronic health record.
Correct Answer: C
Rationale: A printed checklist individualized for the client ensures all essential information is communicated consistently and reduces the risk of omissions during the report.
The nurse is providing discharge teaching for a client post-inguinal herniorrhaphy. Which statement by the client indicates a need for further teaching?
- A. I'll avoid heavy lifting for about 6 weeks.
- B. I can take a shower tomorrow.
- C. I'll call the doctor if I have a fever.
- D. I can resume sexual activity next week.
Correct Answer: D
Rationale: Resuming sexual activity within a week post-inguinal herniorrhaphy may strain the surgical site, indicating a need for further teaching to delay such activities for 4–6 weeks. The other statements align with appropriate postoperative care. CN: Health promotion and maintenance; CL: Evaluate