A nurse is caring for a client who has a cast in place for a fractured tibia. Which of the following nursing actions is the priority immediately after the provider has applied the cast?

Performing range of motion

Checking capillary refill distal to the cast

Teaching the client about cast care

Managing pain

Answer and Explanation

The Correct Answer is B

A. Performing range of motion: This should not be done immediately after applying the cast, as it may compromise the integrity of the cast. Range of motion exercises should be initiated once the cast has fully set and as directed by the healthcare provider.

B. Checking capillary refill distal to the cast: This is the priority after applying the cast. It assesses blood flow to the extremity below the cast. Impaired circulation could lead to serious complications, so it's crucial to monitor capillary refill promptly.

C. Teaching the client about cast care: While providing education about cast care is important, it is not the immediate priority. Ensuring proper circulation is more critical in the initial moments after applying the cast.

D. Managing pain: While pain management is important, it is not the immediate priority after applying the cast. Ensuring proper circulation and assessing for any signs of impairment take precedence. Pain management can be addressed once circulation is confirmed to be adequate.

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Correct Answer is C

Explanation

A. Mild erythema (redness) at the pin sites can be a normal finding due to the body's response to the presence of foreign objects. It may not necessarily indicate infection.

B. Serosanguineous drainage (a mixture of clear and bloody fluid) can also be a normal finding initially after the insertion of pins. It may not necessarily indicate infection.

C. Fever is a systemic response to infection. In a client with skeletal traction, fever can be an indication of an infection at the pin sites or a more systemic infection related to the traction device.

D. Warmth around the pin sites can be a normal finding due to the inflammatory response that occurs after pin insertion. It may not necessarily indicate infection.

A. Instruct the client on use of crutches. B. Direct the client to perform exercises of the ankle and toes. C. Medicate the client for pain. D. Perform neurovascular checks of the extremities.

Correct Answer is D

Explanation

A. Instructing the client on the use of crutches is important but not the most crucial immediately postoperatively. Ensuring the client's neurovascular status is stable takes priority.

B. Directing the client to perform ankle and toe exercises is important for preventing complications like deep vein thrombosis (DVT) and maintaining joint mobility. However, it is not the most critical action in the immediate postoperative period.

C. Medicating the client for pain is essential for comfort and recovery, but it should be based on a pain assessment and should not take precedence over assessing neurovascular status.

D. Performing neurovascular checks of the extremities is the most crucial action in the postoperative period after orthopedic surgery. It helps to ensure there is adequate blood flow and nerve function to the affected limb, which is essential for preventing complications such as compartment syndrome or vascular compromise.

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A nurse is caring for a client who has a cast in place for a fractured tibia. Which of the following nursing actions is the priority immediately after the provider has applied the cast?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who is in skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin sites?

Correct Answer is C

Explanation

A nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period?

Correct Answer is D

Explanation

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