A nurse in an emergency department is caring for a client who has a compound fracture of the right tibia. Which of the following actions should the nurse take?
Keep client in semi-Fowler's position with right extremity flat.
Manage pain with oral opioids every 6 hr.
Check capillary refill hourly for the first 24 hr.
Apply a compression dressing over the fracture site.
The Correct Answer is D
A) Keep client in semi-Fowler's position with right extremity flat: Keeping the client in a semi-Fowler's position with the extremity flat is not appropriate for managing a compound fracture. Elevating the affected limb, if possible, helps reduce swelling and pain, but the position should also consider overall stability and comfort.
B) Manage pain with oral opioids every 6 hr: Oral opioids are not the best choice for immediate pain management in an emergency setting, especially with a compound fracture. Intravenous pain medications are typically more effective for acute, severe pain in such situations and can provide quicker relief.
C) Check capillary refill hourly for the first 24 hr: Checking capillary refill is important to assess blood flow and perfusion, but hourly checks for 24 hours may not be necessary and can be overly frequent unless specific concerns arise. Monitoring should be based on clinical judgment and the client's condition.
D) Apply a compression dressing over the fracture site: Applying a compression dressing over the fracture site can help control bleeding and stabilize the area. Compound fractures involve an open wound, so controlling bleeding while minimizing the risk of infection is crucial. This intervention is essential in managing the initial trauma before more definitive surgical treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Initiate frequent, short periods of exercise throughout the day: Frequent, short periods of exercise are beneficial for a client with left-sided hemiplegia. Regular movement helps maintain joint flexibility, muscle strength, and overall functional ability. This approach can prevent complications such as contractures and muscle atrophy.
B) Decrease the amount of range of motion performed if tightness occurs: If tightness occurs, rather than decreasing range of motion, it is important to address it through appropriate stretching and adjustments in exercise technique. Reducing range of motion could lead to further loss of mobility and function.
C) Perform range-of-motion exercises to the affected side once per day: Performing range-of-motion exercises only once per day is generally insufficient. To maintain or improve mobility and prevent contractures, range-of-motion exercises should be performed multiple times throughout the day, as directed by the care plan.
D) Avoid repetitive movements during exercise: Repetitive movements are not necessarily harmful and can be beneficial for improving motor function and muscle coordination. However, it is important to balance repetitive exercises with variety and adjust based on the client’s condition and tolerance.
Correct Answer is A
Explanation
A) Lymphocytes 30%:
Lymphocyte levels are typically elevated during the acute phase of mononucleosis as the body fights the Epstein-Barr virus. A level of 30% indicates that the lymphocyte count is returning to a more normal range, which suggests the client is recovering from the infection.
B) RBC 4.4:
The red blood cell count is not directly indicative of recovery from mononucleosis. While it provides information about the client's overall hematologic status, it does not specifically reflect the status of the viral infection.
C) Hgb 14 g/dL:
Hemoglobin levels can provide information about the client's oxygen-carrying capacity but do not specifically indicate recovery from mononucleosis. Normal hemoglobin levels are reassuring but not directly related to the viral infection's resolution.
D) Hct 42%:
Hematocrit levels, like hemoglobin, offer information about the client's blood composition but do not directly indicate recovery from mononucleosis. While normal hematocrit levels are desirable, they are not specific to the recovery status of the viral illness.
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