Nokea
The nurse is providing discharge teaching to a patient who has a short-arm plaster cast applied. Which of the following patient statements indicate a good understanding of the discharge teaching?
- A. I can get the cast wet as long as I dry it right away with a hair dryer.
- B. I should avoid moving my fingers and elbow until the cast is removed.
- C. I will apply an ice pack to the cast over the fracture site for the next 24 hours.
- D. I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.
Correct Answer: C
Rationale: Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast. Plaster casts should not get wet. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.
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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.
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.
The nurse is evaluating the crutch-walking technique of a patient who is to have no weight bearing on the right leg. Which of the following observations indicates that the patient can safely ambulate independently?
- A. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.
- B. The patient advances the right leg and both crutches together and then advances the left leg.
- C. The patient moves the left crutch with the left leg and then the right crutch with the right leg.
- D. The patient uses the bedside chair to assist in balance as needed when ambulating in the room.
Correct Answer: B
Rationale: When using crutches, patients are usually taught to move the assistive device and the injured leg forward at the same time and then to move the unaffected leg. Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.
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.
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.