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.

Answer and Explanation

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.

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Correct Answer is A

Explanation

A) Orthostatic hypotension: Anemia often results in decreased blood volume and oxygen-carrying capacity, which can cause orthostatic hypotension. This condition is characterized by a sudden drop in blood pressure when moving from a sitting or lying position to standing, leading to dizziness or fainting.

B) Clubbing of the nail beds: Clubbing is typically associated with chronic hypoxia and long-term respiratory or cardiovascular diseases, rather than anemia. It involves the enlargement of the fingertips and changes in the angle of the nail bed.

C) Conjunctivitis: Conjunctivitis is an inflammation of the conjunctiva, usually caused by infections, allergies, or irritants. It is not a common manifestation of anemia.

D) Heat intolerance: Heat intolerance is more commonly associated with hyperthyroidism or other metabolic disorders rather than anemia. Individuals with anemia are more likely to experience cold intolerance due to reduced oxygen delivery to tissues.

A. "I will remain in the hospital until my treatment is completed." B. "I will wear a surgical mask around my family." C. "I will need medication to treat my condition for the rest of my life." D. "I will need to provide a sputum specimen every 4 weeks until I test negative."

Correct Answer is D

Explanation

A) "I will remain in the hospital until my treatment is completed.": Hospitalization is not typically required for the entire duration of tuberculosis (TB) treatment. Most patients with TB can continue their treatment at home with proper medication and infection control measures, unless they have severe disease or complications.

B) "I will wear a surgical mask around my family.": A surgical mask is not sufficient to protect others from TB. Patients with active TB should wear an N95 respirator mask to reduce the risk of spreading the infection, especially in situations where close contact is unavoidable.

C) "I will need medication to treat my condition for the rest of my life.": TB treatment generally involves a course of medication lasting 6 to 9 months. Long-term, lifelong medication is not required; however, adherence to the full course of prescribed antibiotics is crucial to ensure the infection is fully eradicated.

D) "I will need to provide a sputum specimen every 4 weeks until I test negative.": Monitoring sputum samples every 4 weeks is a standard practice to assess the effectiveness of TB treatment and confirm that the patient is no longer infectious. This statement indicates an understanding of the ongoing evaluation needed during treatment.

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