A nurse is caring for a client who has a compound fracture of the femur.
Which of the following findings should the nurse report to the provider as a manifestation of a fat embolism?

Report of pain as 6 on a scale of 0 to 10.

Pulses 2+ distal to the client’s fracture.

Petechiae over the client’s chest.

Bruising around the fracture site.

Answer and Explanation

The Correct Answer is C

This is a manifestation of a fat embolism, which is a condition where particles of fat get into the bloodstream and block blood flow. A fat embolism can occur after trauma or surgery to the legs, when fat from the bone marrow escapes into the bloodstream.

Choice A is wrong because a report of pain as 6 on a scale of 0 to 10 is not specific to a fat embolism.

Pain is a common symptom of many conditions and injuries.

Choice B is wrong because pulses 2+ distal to the client’s fracture are normal and indicate adequate blood flow to the extremity.

Choice D is wrong because bruising around the fracture site is an expected finding after a compound fracture and does not indicate a fat embolism.

Normal ranges for blood pressure are 90/60 mmHg to 120/80 mmHg and for heart rate are 60 to 100 beats per minute.

Petechiae are small red or purple spots on the skin caused by bleeding under the skin.

They can range in size from pinpoint to several millimeters. Fat embolism syndrome (FES) is a serious complication of a fat embolism that affects the lungs, skin or brain and can be fatal. FES usually occurs 12 to 72 hours after trauma.

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Correct Answer is C

Explanation

Verapamil is a calcium channel blocker that can lower the heart rate and blood pressure. A normal pulse rate for adults is between 60 and 100 beats per minute. A pulse rate of 48/min is too low and indicates bradycardia, which can cause dizziness, fainting, or cardiac arrest. Verapamil should not be given to patients with bradycardia or heart block.

Choice A is wrong because blood pressure 170/82 mm Hg is high and verapamil can help lower it. A normal blood pressure for adults is less than 120/80 mm Hg.

Choice B is wrong because respiratory rate 18/min is normal and verapamil does not affect it. A normal respiratory rate for adults is between 12 and 20 breaths per minute.

Choice D is wrong because potassium 4 mEq/L is normal and verapamil does not affect it. A normal potassium level for adults is between 3.5 and 5.0 mEq/L.

A. Warn the client that the staff will use seclusion as a consequence if there are repeated reports of hallucination. B. Keep the facility’s security personnel constantly visible to the client throughout treatment. C. Collaborate with the client to develop a daily physical exercise routine. D. Agree that the hallucinations are real if the client exhibits aggressive behavior toward other clients.

Correct Answer is C

Explanation

Collaborate with the client to develop a daily physical exercise routine. This intervention can help reduce aggression and impulsivity in schizophrenia by providing an outlet for frustration, enhancing self-esteem, and improving mood. Physical exercise can also improve physical health and reduce the risk of metabolic syndrome associated with antipsychotic medications.

Choice A is wrong because warning the client that the staff will use seclusion as a consequence if there are repeated reports of hallucination is punitive and threatening. This can increase the client’s anxiety, paranoia, and hostility, and may worsen the psychotic symptoms. Seclusion should only be used as a last resort when the client poses a serious danger to self or others, and not as a punishment or coercion.

Choice B is wrong because keeping the facility’s security personnel constantly visible to the client throughout treatment is intimidating and stigmatizing. This can also increase the client’s fear, distrust, and resentment, and may trigger aggressive behavior. Security personnel should only be involved when there is an imminent risk of violence, and not as a routine measure.

Choice D is wrong because agreeing that the hallucinations are real if the client exhibits aggressive behavior toward other clients is reinforcing the delusional belief and rewarding the aggression. This can also confuse the client and undermine the therapeutic relationship.

The nurse should acknowledge the client’s experience of hallucinations, but not endorse them as reality. The nurse should also set clear limits on aggressive behavior and use de-escalation techniques to calm the client.

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A nurse is caring for a client who has a compound fracture of the femur. Which of the following findings should the nurse report to the provider as a manifestation of a fat embolism?

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A nurse is caring for a client who has a compound fracture of the femur.
Which of the following findings should the nurse report to the provider as a manifestation of a fat embolism?