Nokea
Following the application of a fiberglass cast to treat the client's severe ankle sprain (i.e., Grade 3), a nurse performs client education. During this discussion, the client asks, 'How long will my cast take to dry?' Based on this type of cast, the nurse should respond:
- A. Eight hours
- B. 30 minutes
- C. At least 24 hours
- D. At least 48 hours
Correct Answer: B
Rationale: Fiberglass casts typically dry within 30 minutes to an hour, much faster than plaster casts, allowing for quick hardening and stability.
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The nurse performs a focused assessment on a casted patient experiencing increased pain in the affected limb. The nurse notes pallor and swelling distal to the cast area. The patient reports increased pain upon passively moving the extremity. Which of the following fracture-related complications should the nurse be concerned about?
- A. Fat embolism
- B. Infection
- C. Pulmonary embolism
- D. Compartment syndrome
Correct Answer: D
Rationale: Pallor, swelling, and increased pain with passive movement are classic signs of compartment syndrome, a serious complication from pressure buildup in a casted limb. Fat and pulmonary embolisms involve systemic symptoms, and infection typically includes fever.
The nurse in the medical-surgical unit is caring for a newly admitted client.
Item 3 of 6
History and Physical
1930: Client is a 45-year-old male who has a one-and-a-half-week history of pain, redness, and swelling in his right foot. He reported that the symptoms began after he accidentally cut his foot while walking barefoot in his backyard. Over the next few days, he developed pain and swelling around the cut, accompanied by redness and warmth. He went to urgent care two days later and was diagnosed with cellulitis in his right foot. He was prescribed antibiotics but could not afford the treatment. Three days ago, the pain escalated and was described as throbbing and constant, with a severity rating of 7/10 on the Numerical Pain Rating Scale. He states, "the pain is now in the bone of my foot; I don't know how else to describe it." He also noted occasional fever 101°F (38.3°C), chills, and general malaise. On physical examination, his right foot was erythematous, swollen, and warm to the touch. A 3 cm ulcer was noted on the plantar aspect of the right foot, with moderate purulent discharge present. The ulcer appeared deep, and palpation of the surrounding tissue elicited tenderness. There was limited range of motion in the right ankle due to pain. The distal pulses were palpable 2+, and there were signs of neuropathy in the feet (decreased sensation to light touch and pinprick). He has a medical history of uncontrolled diabetes mellitus (type two), obesity, peripheral neuropathy in all extremities, hypertension, hyperlipidemia, and epilepsy.
Consultation
Infectious Disease Consultation
2050: Client was evaluated and I strongly suspect osteomyelitis in his right foot. Labs are pending. Agree with admission and will follow closely.
The nurse reviews the consultation report from the infectious disease physician. Select the complications that the client is at risk for developing? Select all that apply.
- A. Rheumatoid arthritis
- B. Osteosarcoma
- C. Avascular necrosis
- D. Sepsis
- E. Paget's disease
- F. Hyperosmolar hyperglycemic nonketotic syndrome
Correct Answer: C, D
Rationale: With suspected osteomyelitis and uncontrolled diabetes, the client risks avascular necrosis due to poor blood supply and sepsis from untreated infection spreading. Rheumatoid arthritis and osteosarcoma are unrelated, and Paget's is a chronic bone disorder.
The nurse is caring for a client with a newly applied plaster cast. The nurse should
- A. Use a small object like a pencil or ruler to itch the leg if it becomes uncomfortable.
- B. Expedite drying by using a hot blow dryer on the cast.
- C. Let the cast hang below the heart to promote blood flow.
- D. Handle the cast with the palms of the hands.
Correct Answer: D
Rationale: Handling a wet plaster cast with the palms prevents denting, which could cause pressure points. Scratching inside risks skin damage, hot dryers can burn, and a dependent position increases swelling.
A nurse is caring for a client who recently had a cast placed on their right lower extremity. Which statement from the client should be of the greatest concern to the nurse?
- A. I've been having pain in my right calf.'
- B. My right leg feels really itchy.'
- C. I have not been keeping my leg elevated while in bed.'
- D. My hands and arms support my body weight while using crutches.'
Correct Answer: A
Rationale: Pain in the calf may indicate compartment syndrome or deep vein thrombosis, both serious complications requiring urgent attention. Itching is common, elevation is helpful but less urgent, and crutch use is expected.
The nurse is caring for a client with a femur fracture. The client reports chest pain, restlessness, and dyspnea. The nurse suspects that the client has developed fat embolism syndrome (FES). The nurse should take which action?
- A. Place the extremity in a dependent position
- B. Obtain a prescription for hypertonic intravenous fluids
- C. Loosen any dressings on the extremity
- D. Notify the physician
Correct Answer: D
Rationale: Chest pain, restlessness, and dyspnea suggest fat embolism syndrome, a medical emergency. Notifying the physician is critical for rapid intervention. Dependent positioning worsens swelling, hypertonic fluids are unrelated, and loosening dressings helps but is secondary.