Nokea
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.
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In which order will the nurse take these actions when caring for a patient with left leg fractures after a motor vehicle accident?
- A. Obtain x-rays.
- B. Check pedal pulses.
- C. Assess lung sounds.
- D. Take blood pressure.
- E. Apply splint to the leg.
- F. Administer tetanus prophylaxis.
Correct Answer: C,D,B,E,A,F
Rationale: The initial actions should be to ensure that airway, breathing, and circulation are intact. This should be followed by checking the neurovascular status of the leg (before and after splint application). Application of a splint to immobilize the leg should be done before sending the patient for x-rays. The tetanus prophylaxis is the least urgent of the actions.
The nurse is caring for a patient who is a baseball pitcher and had an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which of the following information should be included in the patient's postoperative teaching plan?
- A. You have an appointment with a physical therapist for tomorrow.
- B. You can still play baseball but you will not be able to return to pitching.
- C. The doctor will use the drop-arm test to determine the success of surgery.
- D. Leave the shoulder immobilizer on for the first few days to minimize pain.
Correct Answer: A
Rationale: Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent 'frozen shoulder.' A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of motion (ROM). The drop-arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to return to pitching after rehabilitation.
The nurse is caring for a patient with Buck's traction who had an intracapsular fracture of the left femur. Which of the following actions should the nurse take to evaluate the effectiveness of Buck's traction?
- A. Assess for hip contractures.
- B. Monitor for hip dislocation.
- C. Check the peripheral pulses.
- D. Ask about left hip pain level.
Correct Answer: D
Rationale: Buck's traction keeps the leg immobilized and reduces painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck's traction.
The nurse is planning discharge teaching for a patient who has had a repair of a fractured mandible. Which of the following information will the nurse include in the teaching plan?
- A. When and how to cut the immobilizing wires
- B. Self-administration of nasogastric tube feedings
- C. The use of sterile technique for dressing changes
- D. The importance of including high-fibre foods in the diet
Correct Answer: A
Rationale: The jaw will be wired for stabilization, and the patient should know what emergency situations require that the wires be cut to protect the airway. There are no dressing changes for this procedure. The diet is liquid, and patients are not able to chew high fibre foods. Initially, the patient may receive nasogastric tube feedings, but by discharge the patient will swallow liquid through a straw.
The nurse is caring for a patient who is 1 day postoperative below-the-knee amputation who indicates pain in the amputated limb. Which of the following actions is best for the nurse to take?
- A. Explain the reasons for the phantom limb pain.
- B. Administer prescribed analgesics to relieve the pain.
- C. Loosen the compression bandage to decrease incisional pressure.
- D. Remind the patient that this phantom pain will diminish over time.
Correct Answer: B
Rationale: Phantom limb pain is treated like any other type of postoperative pain would be treated. Explanations of the reason for the pain may be given, but the nurse should still medicate the patient. The compression bandage is left in place except during physical therapy or bathing. Although the pain may decrease over time, it still requires treatment now.