Nokea
Which explanation by the nurse can best help this client understand the injury that has occurred?
- A. One bone end is driven into the other.
- B. One bone end is driven into the other.
- C. There is no open break in the skin.
- D. A portion of the bone is split away.
Correct Answer: C
Rationale: A comminuted fracture involves the bone breaking into multiple fragments, often without an open skin break. The description 'no open break in the skin' distinguishes it from a compound fracture, while the other options describe impacted or avulsion fractures.
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Which assessment finding would the nurse consider a likely adverse effect of the client's methotrexate (Rheumatrex) therapy?
- A. Constipation
- B. Arrhythmia
- C. Mouth sores
- D. Chest pain
Correct Answer: C
Rationale: Mouth sores (stomatitis) are a common adverse effect of methotrexate due to its impact on rapidly dividing cells, like those in the oral mucosa. The other symptoms are less commonly associated.
The client with Alzheimer's dementia is being admitted to the nursing unit following a hip hemiarthroplasty to treat a hip fracture. Which initial intervention should the nurse plan for the client's pain control?
- A. Apply a fentanyl transdermal patch and replace after 24 hours.
- B. Start morphine sulfate per patient-controlled analgesia (PCA) with a basal rate.
- C. Administer intravenous morphine sulfate based on the client's report of pain.
- D. Administer scheduled doses of morphine sulfate intravenously around the clock.
Correct Answer: D
Rationale: D. In addition to scheduling pain medication around the clock, supplemental NSAIDs can be given to reduce inflammation and enhance the effects of the analgesic.
Which area of health teaching is essential to include in the discharge instructions for a client who has undergone a total hip replacement?
- A. Modifying ways of donning clothing
- B. Using special equipment for bathing
- C. Taking vigorous daily walks
- D. Receiving a daily stool softener
Correct Answer: A
Rationale: Modifying clothing application (e.g., avoiding bending or crossing legs) prevents hip dislocation, making it essential for discharge teaching. Vigorous walks are contraindicated, and the other options are less critical.
The nurse is administering 0730 medications to clients on a medical orthopedic unit. Which medication should be administered first?
- A. The daily cardiac glycoside to a client diagnosed with back pain and heart failure.
- B. The routine insulin to a client diagnosed with neck strain and type 1 diabetes.
- C. The oral proton pump inhibitor to a client scheduled for a laminectomy this a.m.
- D. The fourth dose of IV antibiotic for a client diagnosed with a surgical infection.
Correct Answer: B
Rationale: Insulin for type 1 diabetes prevents hyperglycemia, a life-threatening risk, and takes priority. Cardiac glycoside, PPI, and antibiotics are important but less urgent.
If the client is typical of others with a herniated disk, the nurse would expect the client to report which additional symptom?
- A. Pain radiating into the buttocks and leg
- B. Tenderness over one or both iliac crests
- C. Diminished sensation in one or both knees
- D. Brief periods when the toes feel quite cold
Correct Answer: A
Rationale: A herniated lumbar disk commonly causes sciatica, with pain radiating into the buttocks and leg due to nerve root compression. Other symptoms are less typical or specific.