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The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago. The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse?
- A. Call the physician to inform them of the findings.
- B. Administer pain medication.
- C. Request an antihistamine for the allergic reaction.
- D. Increase the intravenous fluids for hemorrhage.
Correct Answer: A
Rationale: The findings of the nurse indicate that the client may have a fat embolus, and the physician should be informed immediately. Administration of pain medication is not indicated at this time. The rash is not indicative of an allergic reaction. There is no indication that the rash is related to hemorrhage, and there is no need to increase the IV fluids.
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A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite what as an advantage of a plaster cast?
- A. Better molding to the client
- B. Quicker drying
- C. Longer lasting
- D. More breathable
Correct Answer: A
Rationale: Plaster casts require a longer time for drying but mold better to the client and are initially used until the swelling subsides. Fiberglass casts dry more quickly, are lighter in weight, longer lasting, and breathable.
A client has a fractured jaw sustained in an automobile accident and has had the fracture surgically reduced and immobilized with a wire loop. What should the nurse ensure is present at the client's bedside in case of vomiting?
- A. Wire cutters
- B. A tracheostomy tray
- C. Ice water with a straw
- D. An antiemetic medication
Correct Answer: A
Rationale: Ensure that wire cutters are easily accessible at the client's bedside. The nurse should be familiar with how to cut wire loops if the client vomits or chokes. A tracheostomy tray is not necessary when an airway can be obtained by cutting the wires so the client does not aspirate. If vomiting occurs, the client should have nothing by mouth. Antiemetic medication should be administered prior to the client vomiting and should not be kept at the bedside.
A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured to the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse?
- A. We will need to monitor the status of the laceration to be sure it does not get infected.
- B. The arm does not require the same immobilization that a leg fracture would.
- C. You will be able to wear the splint longer than you would a cast.
- D. The splint is less expensive than the cast.
Correct Answer: A
Rationale: A splint would be used when there is special skin treatment or observation that is required. The arm fracture would require the same form of immobilization that a leg fracture does. The length of time the splint can be worn is equal to that
of a cast to immobilize the fracture. The cost of the splint and cast would be similar.
A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?
- A. Consult a skin specialist.
- B. Scrub the area vigorously to remove the crust.
- C. Apply lotions and take warm baths or soaks.
- D. Avoid exposure to direct sunlight.
Correct Answer: C
Rationale: The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.
A client is having traction applied to a fractured left lower extremity prior to surgery. What outcome(s) does the nurse expect from the application of the traction for the client? Select all that apply.
- A. Surgery will not be required.
- B. Muscle spasms will be relieved.
- C. The bones of the left leg will be aligned.
- D. Immobilization of the left leg will be maintained.
- E. Less pain medication will be required.
Correct Answer: B,C,D
Rationale: Traction is used to relieve muscle spasm, align bones, and maintain immobilization when used properly. It will not replace surgery to correct the fracture. The client will still require pain medication prior to surgical correction.