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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Remain on bedrest for the first 24 hr.: This is not recommended after arthroscopic knee surgery. Early mobilization and ambulation are encouraged to prevent complications such as blood clots and promote healing.
B. Apply ice to the affected area: This is an important instruction. Applying ice can help reduce swelling and pain after surgery. It's typically recommended for the first 24-48 hours.
C. Begin active range of motion: While range of motion exercises are important, they should be initiated as directed by the healthcare provider, and they should be done gently to avoid straining the surgical site.
D. Keep the leg in a dependent position: This is not recommended. Elevating the leg can help reduce swelling and promote circulation. Keeping the leg in a dependent position could exacerbate swelling and discomfort.
Correct Answer is ["33"]
Explanation
- To calculate the gtt/min, use the formula: gtt/min = (volume in mL x drop factor) / time in min
- Plug in the values from the question: gtt/min = (100 mL x 10 gtt/mL) / 30 min - Simplify and solve: gtt/min = 1000 gtt / 30 min
- Divide both sides by 30: gtt/min = 33.33 gtt/min
- Round to the nearest whole number: gtt/min = 33 gtt/min
- The nurse should set the manual IV infusion to deliver 33 gtt/min
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