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The nurse is preparing a patient for discharge from the emergency department with a sprained wrist. Which of the following information should the nurse include?
- A. Keep the wrist loosely wrapped with gauze.
- B. Apply a heating pad to reduce muscle spasms.
- C. Use pillows to elevate the arm above the heart.
- D. Gently move the wrist through the range of motion.
Correct Answer: C
Rationale: Elevation of the arm will reduce the amount of swelling and pain. Compression bandages are used to decrease swelling. For the first 24-48 hours, cold packs are used to reduce swelling. The wrist should be rested and kept immobile to prevent further swelling or injury.
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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 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.
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 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 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.