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The nurse is caring for a patient in the emergency department with repetitive strain injury to the left elbow as a result of his employment as a checkout clerk in the grocery. Which of the following actions should the nurse include in the plan of care?
- A. Surgical options
- B. Elbow injections
- C. Use a wrist splint
- D. Modifications in arm movement
Correct Answer: D
Rationale: Treatment for a repetitive strain injury includes changing the ergonomics of the activity. Elbow injections and surgery are not initial options for this type of injury. A wrist splint might be used for hand or wrist pain, not elbow injuries.
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The nurse is caring for a patient with a fractured pelvis and on day 2 of the hospitalization the patient develops acute onset confusion. Which of the following actions should the nurse take first?
- A. Take the blood pressure.
- B. Assess patient orientation.
- C. Check pupil reaction to light.
- D. Assess the oxygen saturation.
Correct Answer: D
Rationale: The patient's history and clinical manifestations suggest a fat embolus. The most important assessment is oxygenation. The other actions also are appropriate but will be done after the nurse assesses gas exchange.
The nurse is admitting a patient to the emergency department after falling on the right arm and shoulder. Which of the following findings is most important for the nurse to communicate to the health care provider immediately?
- A. There is bruising at the shoulder area.
- B. The right arm appears shorter than the left.
- C. There is decreased range of motion of the shoulder.
- D. The patient is complaining of arm and shoulder pain.
Correct Answer: B
Rationale: A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. Bruising, pain, and decreased range of motion also should be reported, but these do not indicate that emergent treatment is needed to preserve function.
The nurse is preparing a patient with lower leg fracture and an external fixation device in place for discharge. Which of the following information should the nurse include in the discharge teaching?
- A. You will need to assess and clean the pin insertion sites daily.
- B. The external fixator can be removed during the bath or shower.
- C. You will need to remain on bed rest until bone healing is complete.
- D. Prophylactic antibiotics are used until the external fixator is removed.
Correct Answer: A
Rationale: Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given when an external fixator is used.
The nurse is caring for a patient in the emergency department who has a soft tissue injury and an open leg fracture. Which of the following actions should the nurse implement first?
- A. If dislocation, apply compression bandage.
- B. Realignment of the bone(s).
- C. Administer tetanus with an open fracture.
- D. Apply heat to the affected area.
Correct Answer: C
Rationale: An initial action in the emergency treatment of soft tissue injuries is to administer tetanus if there is evidence of an open fracture. If dislocation is suspected, a compression bandage is contraindicated. The nurse would apply ice, not heat, to the affected area. Realignment of the bone is not to be attempted.
The nurse is preparing a patient for discharge 4 days after insertion of a femoral head prosthesis using a posterior approach. Which of the following patient statements indicate a need for additional discharge instructions?
- A. I should not cross my legs while sitting.
- B. I will use a toilet elevator on the toilet seat.
- C. I will have someone else put on my shoes and socks.
- D. I can sleep in any position that is comfortable for me.
Correct Answer: D
Rationale: The patient needs to sleep in a position that prevents excessive internal rotation or flexion of the hip. The other patient statements indicate that the patient has understood the teaching.