Nokea
The nurse is caring for a patient who has a cast in place after fracturing the radius and the patient asks when the cast can be removed. Which of the following information related to the length of time that the cast will need to remain in place should the nurse tell the patient?
- A. Several months
- B. At least 3 weeks
- C. Until swelling of the wrist has resolved
- D. Until x-rays show complete bony union
Correct Answer: B
Rationale: Bone healing starts immediately after the injury, but since ossification does not begin until 3 weeks postinjury, the cast will need to be worn for at least 3 weeks. Complete union may take up to a year. Resolution of swelling does not indicate bone healing.
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Which of the following information obtained by the emergency department nurse when admitting a patient with a left femur fracture is most important to report to the health care provider?
- A. Bruising of the left thigh
- B. Complaints of left thigh pain
- C. Outward pointing toes on the left foot
- D. Prolonged capillary refill of the left foot
Correct Answer: D
Rationale: Prolonged capillary refill may indicate complications such as arterial damage or compartment syndrome. The other findings are typical with a left femur fracture.
The nurse is counseling a patient about ways to prevent fractures. Which of the following information should the nurse include?
- A. Tack down throw rugs in the home.
- B. Most falls happen outside the home.
- C. Buy shoes that provide good support and are comfortable.
- D. Activities of daily living provide range of motion.
Correct Answer: C
Rationale: Comfortable shoes with good support will help decrease the risk for falls. Throw rugs should be eliminated, not just tacked down. Most falls occur inside the home, and activities of daily living do not necessarily provide sufficient range of motion to prevent fractures.
Before assisting a patient with ambulation on the day after a total hip replacement, which of the following actions is most important for the nurse to implement?
- A. Administer the ordered oral opioid pain medication.
- B. Instruct the patient about the benefits of ambulation.
- C. Ensure that the incisional drain has been discontinued.
- D. Change the hip dressing and document the wound appearance.
Correct Answer: A
Rationale: The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the patient's willingness to ambulate, but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not affect ambulation.
The nurse is caring for a patient who has a long-arm plaster cast applied for immobilization of a fractured left radius. Which of the following actions should the nurse implement until the cast has completely dried?
- A. Keep the left arm in a dependent position.
- B. Handle the cast with the palms of the hands.
- C. Place gauze around the cast edge to pad any roughness.
- D. Cover the cast with a small blanket to absorb the dampness.
Correct Answer: B
Rationale: Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent creating areas inside the cast that could place pressure on the arm. The left arm should be elevated to prevent swelling. The edges of the cast may be petalled once the cast is dry but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.
The nurse is providing discharge teaching to a patient with a sprained right ankle. Which of the following information should be included in the teaching plan? (Select all that apply.)
- A. Elevate the limb.
- B. Use nonsteroidal anti-inflammatory drugs as required.
- C. Apply warm moist heat for 45 minutes, three times per day.
- D. Use an elastic bandage on the ankle during activity.
- E. Use ice alternating with heat 48 hours after the injury.
Correct Answer: A,B,D
Rationale: Teaching instructions for a sprain include elevation of the limb at all times, even during sleep, using NSAIDs for discomfort, and an elastic bandage during activity. Warm moist heat can be applied but it is not to exceed 30 minutes. Ice is only to be used during the initial 24-48 hours after the injury.