Nokea
Which nursing intervention is most appropriate for preventing a pathological fracture?
- A. Encouraging a high fluid intake
- B. Providing a nutritional diet
- C. Supporting the limb during movement
- D. Relieving pressure on bony prominences
Correct Answer: C
Rationale: Supporting the limb prevents stress on weakened bone, reducing fracture risk.
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When assessing the characteristics of pain in a client with a herniated disk, the nurse would expect to document increased intensity of pain during which activity?
- A. Eating
- B. Coughing
- C. Sleeping
- D. Urinating
Correct Answer: B
Rationale: Coughing increases intraspinal pressure, exacerbating pain from a herniated disk by compressing the affected nerve root. Other activities are less likely to intensify disk-related pain.
The client diagnosed with osteomyelitis of the left foot and ankle is being prepared for a below-the-knee amputation. Which intervention to improve the client’s functional ability is a priority after rehabilitation?
- A. Keep a large tourniquet at the bedside to stop potential bleeding from the amputation site.
- B. Place a pillow in the bed for the client to push the stump against many times per day.
- C. Take and document the client’s vital signs every four (4) hours.
- D. Have the dietary department send high protein, high-carbohydrate meals six (6) times a day.
Correct Answer: B
Rationale: Pushing the stump against a pillow toughens the residual limb, improving prosthesis use and function post-amputation. Tourniquets are for emergencies, vitals are routine, and frequent meals are excessive.
Which material added by the nurse is best for covering the tips of the pin to prevent injuries while the client is in skeletal leg.
- A. Gauze squares
- B. Cotton balls
- C. Cork blocks
- D. Rubber tubes
Correct Answer: C
Rationale: Cork blocks securely cover pin tips, preventing injury to the client or staff while maintaining stability. Gauze and cotton are less durable, and rubber tubes may not fit securely.
The client is to be discharged after receiving treatment for right shoulder tendonitis. Which actions indicate to the nurse that the client is ready for discharge? Select all that apply.
- A. Verbalizes about resuming normal activities within a day or two
- B. Demonstrates proper use of an arm sling and the need to wear it during sleep
- C. Verbalizes to keep the arm extended and flat on the mattress when lying in bed
- D. Demonstrates how to properly apply the ice packs on the shoulder joint
- E. States will take ibuprofen every four to six hours as needed for pain
Correct Answer: B,D,E
Rationale: B. An arm sling helps to rest the joint and keep it stabilized, especially during sleep. D. Ice application reduces joint inflammation and pain associated with tendonitis. E. NSAIDs such as ibuprofen (Motrin) are effective for controlling pain and reducing inflammation with tendonitis.
Which statement should the nurse include in the instructions for parents of an infant with osteogenesis imperfecta (OI)?
- A. "Check the color of your infant's nailbeds and mucous membranes for signs of circulatory impairment."
- B. "If you note signs of infection, bring your infant to the clinic because the infant has a significant immune dysfunction."
- C. "Protect your infant from injury and handle your baby carefully because your infant's bones can break very easily."
- D. "Notify your physician if your infant does not respond to sound because the infant's CNS fails to develop completely."
Correct Answer: C
Rationale: OI causes brittle bones, so careful handling is essential to prevent fractures.