Nokea
A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses a capillary refill of 5 seconds and cold fingers of the right hand. Which initial intervention should the nurse deploy?
- A. Notify the charge nurse of a probable compartment syndrome.
- B. Apply a warm compress to the fingers to relieve swelling.
- C. Elevate the right hand to heart level to maintain arterial pressure.
- D. Cut the cast off to release constriction.
Correct Answer: C
Rationale: The nurse should first elevate the right hand to heart level and notify the charge nurse. Permanent damage can occur in as little time as 6 hours. While the charge nurse does need to be notified it is most crucial to elevate the hand to heart level first. A warm compress would likely cause blood vessels to dilate, worsening the edema. The nurse cannot independently cut the cast off.
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A patient's patellar-femoral cartilage has deteriorated due to arthritis. The medial and lateral cartilage is undamaged. This patient is likely to undergo partial or knee replacement surgery.
Correct Answer: unicompartmental
Rationale: Unicompartmental knee arthroplasty is also referred to as partial knee replacement and is performed on patients who have only one of the compartments of the knee affected by arthritis.
When the patient with rheumatoid arthritis reports not liking daily exercise, the nurse encouragingly reminds the patient that exercise has which benefit?
- A. Keeping the joints from 'freezing.'
- B. Ensuring longer and better sleep.
- C. Stimulating joints when done vigorously
- D. When performed weekly, having greater benefits.
Correct Answer: A
Rationale: Daily gentle exercises keep the joints from 'freezing' and keep the muscles from weakening. Exercise does not ensure better sleep. Joint exercises should not be performed vigorously. The patient benefits when gently exercises are performed daily.
Which instruction will the nurse reinforce for a patient who is taking alendronate?
- A. Take drug with any meal.
- B. Take drug first thing in the morning.
- C. Drink at least $5 \mathrm{oz}$ of milk before taking drug.
- D. Take drug with an antacid to avoid heartburn.
Correct Answer: B
Rationale: Alendronate should be taken on an empty stomach first thing in the morning with $6 \mathrm{oz}$ of water, accompanied by no other medication. The patient should remain upright for 30 minutes after a dose to minimize risk of esophageal irritation.
Which action should the nurse take when a patient with osteomyelitis of the right forearm is admitted with an open wound that is draining?
- A. Enforce a low-calorie diet.
- B. Initiate drainage and secretion precautions.
- C. Frequently do passive ROM on the elbow.
- D. Ambulate several times daily.
Correct Answer: B
Rationale: The patient with osteomyelitis should be at least in drainage and secretion precaution. The limb should be positioned for maximum comfort and left at rest. These patients are usually on bed rest and require a high-calorie, high-protein diet.
The patient that has a bipolar hip replacement following an intracapsular fracture has an order to be turned every 2 hours. The nurse understands that the correct nursing intervention is to keep the legs in which position?
- A. together so they do not separate while turning.
- B. flexed to stabilize the prosthesis.
- C. abducted so the prosthesis does not become dislocated.
- D. adducted to prevent additional pain for the patient with turning.
Correct Answer: C
Rationale: Nursing interventions also involve postoperative maintenance of leg abduction by using an abduction splint for 7 to 10 days to prevent dislocation of the prosthesis. Leg abduction does not involve keeping the legs together, flexion to stabilize the prosthesis or to keep the legs adducted to prevent additional pain with turning.