Nokea
The nurse is caring for a patient who arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. Which of the following prescribed collaborative interventions will the nurse implement first?
- A. Wrap the ankle and apply an ice pack.
- B. Administer naproxen 500 mg PO.
- C. Give acetaminophen with codeine.
- D. Take the patient to the radiology department for x-rays.
Correct Answer: A
Rationale: Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.
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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.
The nurse is caring for a patient who has just arrived on the orthopedic unit after a right above-the-knee amputation with an immediate prosthetic fitting. Which of the following actions should the nurse implement first?
- A. Place the patient in a prone position.
- B. Check the surgical site for hemorrhage.
- C. Remove the prosthesis and wrap the site.
- D. Keep the residual leg elevated on a pillow.
Correct Answer: B
Rationale: The nurse should monitor for hemorrhage after the surgery. The prosthesis will not be removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. The patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period.
The nurse is caring for a patient who has had an open reduction and internal fixation (ORIF) of left lower leg fractures who indicates constant severe pain in the leg which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which of the following actions should the nurse take next?
- A. Notify the health care provider.
- B. Assess the incision for redness.
- C. Reposition the left leg on pillows.
- D. Check the patient's blood pressure.
Correct Answer: A
Rationale: The patient's clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment. The data do not suggest problems with blood pressure or infection. Elevation of the leg will decrease arterial flow and further reduce perfusion.
After the health care provider has recommended an amputation for a patient who has ischemic foot ulcers, the patient tells the nurse, 'If they want to cut off my foot, they should just shoot me instead.' Which of the following responses by the nurse is best?
- A. Many people are able to function normally with a foot prosthesis.
- B. I understand that you are upset, but you may lose the foot anyway.
- C. Tell me what you know about what your options for treatment are.
- D. If you do not want the surgery, you do not have to have an amputation.
Correct Answer: C
Rationale: The initial nursing action should be to assess the patient's knowledge level and feelings about the options available. Discussion about the patient's option to not have the procedure, the seriousness of the condition, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient's current level of knowledge and emotional state.
The nurse is providing health-promotion teaching to a patient whose job involves many hours of word processing. Which of the following actions should the nurse include in the patient teaching plan?
- A. Do stretching and warm-up exercises before starting work.
- B. Use a compression bandage to prevent wrist pain.
- C. Take nonsteroidal anti-inflammatory drugs (NSAIDs) for wrist pain.
- D. Obtain a keyboard pad to support the wrist while word processing.
Correct Answer: D
Rationale: Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented by the use of a pad that will keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to use to decrease swelling but are not a preventive measure.