A client with a compound fracture of the left ankle is being discharged with a below-the-knee cast. Which

instruction should the practical nurse (PN) provide to the client prior to discharge?

Choice A reason: The client's financial resources are not the most important factor for the nurse to consider because Meals-on-Wheels is a program that provides low-cost or free meals to seniors and people with disabilities who are unable to cook or shop for themselves.

Choice B reason: The client's level of family support is not the most important factor for the nurse to consider because Meals-on-Wheels is a program that aims to reduce social isolation and improve nutrition for homebound clients, regardless of their family situation.

Choice C reason: The client's access to transportation is not the most important factor for the nurse to consider because Meals-on-Wheels is a program that delivers meals directly to the client's home, eliminating the need for transportation.

Choice D reason: The client's ability to prepare meals is the most important factor for the nurse to consider because Meals-on-Wheels is a program that caters to clients who have difficulty or inability to cook or shop for themselves due to physical, mental, or environmental limitations.

When providing instructions to a client with a below-the-knee cast for a compound fracture of the left ankle, it is important to prioritize their safety and proper care of the cast. The instruction to never scratch under the cast is crucial for preventing complications and maintaining the integrity of the cast.

Let's evaluate the other options:

a) Apply a cold pack to any "hot spots" on the cast.

Applying a cold pack to any "hot spots" on the cast may help alleviate discomfort or itching, but it is not the highest priority instruction. Preventing scratching under the cast is more important to avoid skin damage or infection.

b) Keep the left leg in a dependent position.
Keeping the left leg in a dependent position (hanging down) is not the appropriate instruction for a client with a below-the-knee cast. It is generally recommended to elevate the injured limb to reduce swelling and promote proper blood flow. Elevating the leg would involve keeping it raised above the level of the heart.

c) Expect some increase in pain.
While it is possible for the client to experience some increase in pain after the application of a cast, this instruction alone is not comprehensive or specific enough for proper discharge education. Providing information about pain management strategies or when to seek medical atention for excessive pain would be more appropriate.

In summary, when discharging a client with a compound fracture of the left ankle and a below-the-knee cast, the practical nurse (PN) should provide the instruction to never scratch under the cast. This helps prevent complications and maintain the integrity of the cast, promoting proper healing of the fracture.