A nurse in an emergency department is caring for a client who is actively bleeding from a stab wound to the thigh.
Which of the following actions should the nurse take?

Choice A rationale:

"Uneven shoulder and pelvic heights." This is the correct answer. Uneven shoulder and pelvic heights, along with an asymmetrical appearance of the spine when viewed from the back, are clinical manifestations of scoliosis. Scoliosis is a sideways curvature of the spine that often develops during the growth spurt before puberty. Screening for scoliosis typically involves assessing the alignment of the spine and looking for these asymmetries.

Choice B rationale:

Exaggerated curvature of the sacrum is not a typical sign of scoliosis. Scoliosis primarily affects the upper back and can cause a side-to-side curvature of the spine, not the sacrum.

Choice C rationale:

Limited range-of-motion of the hips is not a specific indicator of scoliosis. Restricted hip movement might suggest other musculoskeletal issues but is not directly related to scoliosis.

Choice D rationale:

Mild pain in the hip region is not a characteristic symptom of scoliosis. While scoliosis can cause discomfort, it typically manifests as back pain, not specifically in the hip region. Pain symptoms can vary widely among individuals and might not be present in all cases of scoliosis.

The correct answer is: b: Perform the procedure prior to meals.

Choice A rationale: The rationale for Choice A involves understanding the technique of percussion in postural drainage for cystic fibrosis management. Percussion is a component of chest physiotherapy that involves rhythmic clapping or tapping on the chest wall to help loosen and mobilize secretions within the airways. However, holding the hand flat during percussion may not effectively transmit the necessary force to the chest wall for optimal secretion mobilization. Instead, cupping the hands allows for better resonance and transmission of percussion force, enhancing the effectiveness of the procedure.

Choice B rationale: Performing postural drainage prior to meals is the recommended timing for several reasons. Firstly, initiating the procedure before meals allows the child's stomach to be relatively empty, reducing the risk of discomfort, nausea, or vomiting during the procedure. Secondly, performing postural drainage before meals helps prevent aspiration of stomach contents, which can occur if the child vomits during or after the procedure. Aspiration poses significant risks, including lung infection and respiratory distress, particularly in individuals with compromised respiratory function such as those with cystic fibrosis.

Choice C rationale: While bronchodilators may play a role in managing airway obstruction in cystic fibrosis, administering them after postural drainage is not a standard practice. Bronchodilators are typically used to alleviate bronchoconstriction and improve airflow in the lungs. However, their administration after postural drainage may not be directly related to the immediate goals of the procedure, which are to mobilize and clear pulmonary secretions. The timing of bronchodilator administration is often guided by the individual's clinical condition and the presence of symptoms such as wheezing or shortness of breath.

Choice D rationale: Performing postural drainage twice daily may not provide adequate frequency for managing secretions in individuals with cystic fibrosis. The goal of postural drainage is to facilitate the removal of thick, tenacious mucus from the airways to improve respiratory function and reduce the risk of complications such as infections. In cystic fibrosis, mucus clearance is essential for maintaining pulmonary health and preventing exacerbations. Therefore, a more frequent regimen, often including multiple sessions of postural drainage per day, may be necessary to achieve optimal therapeutic outcomes and prevent mucus accumulation and airway obstruction.