Nokea
A nurse cares for an older adult client with multiple fractures. Which action should the nurse take to manage this client's pain?
- A. Administer meperidine every 4 hours around the clock.
- B. Patient-controlled analgesia (PCA) pump with morphine.
- C. Ibuprofen (Motrin) 600 mg orally every 4 hours PRN for pain.
- D. Morphine 2 mg intravenous push every 4 hours PRN for pain.
Correct Answer: B
Rationale: The older adult client should not be treated with meperidine because toxic metabolites can cause seizures. A PCA pump with morphine is the best option for controlling pain in this client. Ibuprofen may not provide sufficient pain relief for multiple fractures, and PRN morphine may not maintain consistent pain control.
You may also like to solve these questions
An emergency nurse assesses a client who is admitted with a pelvic fracture. Which assessments should the nurse monitor? (Select all that apply.)
- A. Temperature
- B. Urinary output
- C. Blood pressure
- D. Pulse rate
- E. Level of consciousness
Correct Answer: A,B,C,D,E
Rationale: A client with a pelvic fracture is at risk for complications such as internal bleeding, infection, and shock. Monitoring temperature can indicate infection, urinary output can reflect kidney function or hypovolemia, blood pressure and pulse rate can indicate hemodynamic stability, and level of consciousness can signal neurological changes or shock. These assessments are critical for client safety.
A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery. Which actions should the nurse include in this client's plan of care? (Select all that apply.)
- A. Elevate heels off the bed with a pillow.
- B. Ambulate the client on the first postoperative day.
- C. Use an abduction pillow to prevent hip subluxation.
- D. Re-position the client every 2 hours.
- E. Push the client's patient-controlled analgesia button.
Correct Answer: A,B,C,D
Rationale: Postoperative care for a client who has ORIF of the hip includes elevating the client's heels off the bed and repositioning every 2 hours to prevent pressure and skin breakdown, ambulating the client on the first postoperative day, and using pillows or an abduction pillow to prevent subluxation of the hip. The nurse should never push the patient-controlled analgesia button for the client.
A phone triage nurse speaks with a client who has an arm cast. The client states, 'My arm feels really tight and puffy.' How should the nurse respond?
- A. Elevate your arm on two pillows and get ice to apply to the cast.
- B. Continue to take ibuprofen (Motrin) until the swelling subsides.
- C. This is normal. A new cast will often feel a little tight for the first few days.
- D. Please come to the clinic today to have your arm checked by the provider.
Correct Answer: D
Rationale: Puffy fingers and a feeling of tightness from the cast may indicate the development of compartment syndrome. The client should come to the clinic that day to be evaluated by the provider because delay of treatment can cause permanent damage to the extremity. Ice and ibuprofen are acceptable actions, but checking the cast is the priority to ensure client safety. The nurse should not reassure the client that this is normal.
A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take immediate action?
- A. Pain of 4 on a scale of 0 to 10.
- B. Numbness in the extremity.
- C. Swollen extremity at the injury site.
- D. Feeling cold while lying in bed.
Correct Answer: B
Rationale: The client with numbness and/or tingling of the extremity may be displaying the first signs of acute compartment syndrome. This is an acute problem that requires immediate intervention because of possible decreased circulation. Moderate pain and swelling are expected after a fracture and can be treated with comfort measures. Feeling cold can be addressed with additional blankets or increasing the room temperature.
These symptoms represent early warning signs of acute compartment syndrome. Which action should the nurse take first?
- A. Assess the pedal pulses.
- B. Apply oxygen by nasal cannula.
- C. Increase the IV flow rate.
- D. Loosen the traction.
Correct Answer: A
Rationale: These symptoms represent early warning signs of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesia precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible. Vital signs need to be obtained to determine if oxygen and intravenous fluids are necessary. Traction, if implemented, should never be loosened without a provider's prescription.