A nurse is assessing a client following the application of a leg cast for the treatment of a fracture. If the cast is too tight, which of the following findings should the nurse expect to observe first?

Inability to move toes.

Pallor of the toes.

Change in temperature of the toes.

Edema of the toes.

Answer and Explanation

The Correct Answer is B

A. Inability to move toes may be a sign of tightness in the cast, but it is not the first finding to be expected if the cast is too tight.

B. Pallor of the toes indicates compromised blood flow and is the earliest sign of circulatory impairment due to tightness of the cast.

C. Change in temperature of the toes may be a sign of impaired circulation, but it is not the earliest finding to be expected.

D. Edema of the toes may occur as a result of compromised circulation, but it is not the first finding to be expected if the cast is too tight.

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Correct Answer is B

Explanation

A. Inserting sterile packing into the nares is not indicated in this situation. Clear fluid drainage from the nose may be cerebrospinal fluid (CSF), and packing could cause further complications.

B. Allowing the drainage to drip onto a sterile gauze pad is the appropriate initial action. Clear fluid drainage from the nose after a traumatic event may be CSF, which can indicate a skull fracture and damage to the meninges. Collecting the fluid on a sterile gauze pad can help confirm the presence of CSF.

C. Suctioning the nose with a bulb syringe is not recommended because it can introduce contaminants into the nasal passages and potentially worsen the injury.

D. Obtaining a culture of the specimen using sterile swabs is a consideration once the presence of CSF is confirmed. However, the initial priority is to identify and collect the clear fluid drainage.

A. When moving an object to one side, the client puts his weight on his heels. B. The client stands with his feet close together when lifting an object. C. The Client faces the direction of movement when sliding an object across the floor. D. When pushing an object, the client moves his front foot backward.

Correct Answer is C

Explanation

A. Placing weight on the heels when moving an object can lead to an improper body mechanic. The client should shift their weight onto the balls of their feet for better stability.

B. Standing with feet close together when lifting an object can also lead to improper body mechanics. The client should maintain a wide base of support by keeping their feet shoulder-width apart.

C. Facing the direction of movement when sliding an object across the floor is an example of proper body mechanics. It helps ensure that the client uses their body weight and strength efficiently.

D. Moving the front foot backward when pushing an object can help maintain balance and provide better leverage, which is a correct body mechanics technique. However, the question specifically asks about sliding an object across the floor, not pushing.

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A nurse is assessing a client following the application of a leg cast for the treatment of a fracture. If the cast is too tight, which of the following findings should the nurse expect to observe first?

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Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

A nurse is assessing a client at a follow-up clinic visit for acute low back pain. A goal for this client is to use proper body mechanics at all times. Which of the following findings indicates that the client is meeting this goal?

Correct Answer is C

Explanation

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