Nokea
The nurse is caring for a patient with ulnar drift caused by rheumatoid arthritis (RA) who is scheduled for an arthroplasty of the hand. Which of the following patient statements indicate realistic expectation for the surgery?
- A. I will be able to use my fingers to grasp objects better.
- B. I will not have to do as many hand exercises after the surgery.
- C. This procedure will prevent further deformity in my hands and fingers.
- D. My fingers will appear more normal in size and shape after this surgery.
Correct Answer: A
Rationale: The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Hand exercises will be prescribed after the surgery.
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The nurse is caring for a patient who is on bed rest after having a complex pelvic fracture. Which of the following assessment findings is most important to report to the health care provider?
- A. The patient states that the pelvis feels unstable.
- B. Abdominal distention is present and bowel tones are absent.
- C. There are ecchymoses on the abdomen and hips.
- D. The patient complains of pelvic pain with palpation.
Correct Answer: B
Rationale: The abdominal distention and absent bowel tones may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon. Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected with this type of injury.
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.
The nurse is caring for a patient who develops sudden shortness of breath, chest pain, and cyanosis several days after surgical fixation of a fractured femur. Which of the following actions should the nurse take first?
- A. Obtain vital signs.
- B. Notify the health care provider.
- C. Administer the prescribed anticoagulant.
- D. Apply high-flow oxygen by non-rebreather mask.
Correct Answer: D
Rationale: The patient's clinical manifestations and history are consistent with a fat embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient, but meeting the physiological need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for fat embolus or venous thromboembolism (VTE) are obtained.
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 caring for a patient in the emergency department who is experiencing severe pain and is diagnosed with a patellar dislocation. Which of the following actions should the nurse implement first?
- A. Applying a knee immobilizer
- B. Implementing passive knee flexion
- C. Limiting activity restrictions
- D. Preparing the patient for conscious sedation
Correct Answer: D
Rationale: The first goal of collaborative management is realignment of the knee to its original anatomic position, which will require anesthesia or conscious sedation. Immobilization, gentle range of motion (ROM) exercises, and discussion about activity restrictions will be implemented after the knee is realigned.