A 68-year-old male patient, who had bilateral total hip arthroplasty two years ago, arrived at the emergency department by ambulance.
He reports that he slipped while putting away groceries at home.
He did not feel dizzy or lightheaded before the fall.
He fell face-forward, hitting his head on the wall and his left shoulder on the floor.
He reports pain mainly in his left shoulder.
As a nurse, what interventions should you plan to reduce further complications?
Administer morphine as prescribed.
Monitor the patient’s vital signs.
Apply a cold pack to the affected area.
Arrange for an X-ray of the left shoulder.
Correct Answer : A,B,C,D
D.
Choice A rationale
Administering morphine as prescribed would help to manage the patient’s reported pain.
Choice B rationale
Monitoring the patient’s vital signs is crucial in assessing the patient’s physiological response to the fall and ensuring stability.
Choice C rationale
Applying a cold pack to the affected area can help to reduce swelling and alleviate pain.
Choice D rationale
Arranging for an X-ray of the left shoulder would help to identify any potential fractures or other injuries resulting from the fall.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
While altered taste sensation can occur with radiation treatment, it’s not the most likely reason for an imbalance in nutritional intake in this scenario.
Choice B rationale
Fatigue can be a side effect of radiation treatment, but it’s not the primary reason for an imbalance in nutritional intake in this case.
Choice C rationale
Pain during eating is the most likely cause of imbalanced nutritional intake in this scenario. The patient’s laryngeal cancer and the development of mucositis indicate that eating is likely painful for them. This discomfort can significantly deter the patient from eating, leading to decreased nutritional intake.
Choice D rationale
Nausea can occur with radiation treatment, but it’s not the primary reason for an imbalance in nutritional intake in this case.
Correct Answer is ["A","C","F","H"]
Explanation
H.
Choice A rationale
Monitoring the oxygen saturation is an important nursing intervention following the administration of albuterol. Albuterol is a bronchodilator and should improve oxygen saturation by increasing airflow and oxygen delivery.
Choice B rationale
Deep tracheal suctioning is not typically required following the administration of albuterol unless the patient has excessive secretions or difficulty clearing secretions.
Choice C rationale
Discussing potential asthma triggers with the client is an important nursing intervention. Understanding and avoiding triggers can help prevent future asthma exacerbations.
Choice D rationale
Obtaining a sputum culture is not typically required following the administration of albuterol unless there is a suspicion of a respiratory infection.
Choice E rationale
Positive pressure ventilation is not typically required following the administration of albuterol unless the patient is in severe respiratory distress.
Choice F rationale
Allowing the client to take a position of comfort can help improve breathing and should be encouraged.
Choice G rationale
Discussing aggressive respiratory treatment options is not typically required following the administration of albuterol unless the patient’s condition is not improving or worsening.
Choice H rationale
Weaning the supplemental oxygen may be appropriate following the administration of albuterol if the patient’s oxygen saturation has improved.
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