A nurse is caring for a client who has multiple long bone fractures caused by a motor-vehicle crash that happened 24 hr ago. The client tells the nurse he is short of breath and experiencing chest pain. The nurse should assess the client further for which of the following potential complications?

Hypovolemic shock

Fat embolism syndrome

Venous thromboembolism

Compartment syndrome

Answer and Explanation

The Correct Answer is B

A. Hypovolemic shock is characterized by a significant loss of blood volume. While it can occur due to severe trauma, the symptoms of shortness of breath and chest pain are more indicative of a potential respiratory issue, making Fat Embolism Syndrome (FES) a higher concern in this case.

B. Correct. Given the client's recent multiple long bone fractures and the symptoms of shortness of breath and chest pain, the nurse should be concerned about the possibility of fat embolism syndrome (FES). FES can occur as a result of long bone fractures, particularly those involving the femur, pelvis, or tibia. Fat emboli can enter the bloodstream and potentially obstruct blood vessels, leading to symptoms such as shortness of breath, chest pain, and altered mental status.

C. Venous thromboembolism (VTE) is a condition involving the formation of blood clots in the veins, which can lead to complications such as deep vein thrombosis (DVT) or pulmonary embolism (PE). While this is a consideration for clients with immobilization due to fractures, it is not the primary concern in this case based on the presenting symptoms.

D. Compartment syndrome is a condition characterized by increased pressure within a muscle compartment, leading to decreased blood flow and potential tissue damage. While it can occur after fractures, it typically presents with symptoms like severe pain, swelling, and tense muscles, rather than shortness of breath and chest pain.

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Correct Answer is A

Explanation

A. "Your pain will gradually become less severe." This statement is accurate and provides realistic expectations for the client. After an amputation, there will be initial post operative pain, but it should gradually decrease over time.

B. "The pain will disappear soon." This statement is not accurate. While the pain will eventually decrease, it may not completely disappear immediately after the procedure.

C. "It's likely that you will have only a tingling sensation." This statement is not accurate. While some clients may experience tingling sensations, it is not the only sensation they may feel, and this statement does not cover the full range of possible experiences.

D. "Phantom pain is mostly psychological." This statement is not accurate. Phantom pain is a real sensation that some individuals experience after an amputation. It is believed to be related to nerve endings that continue to send signals to the brain even though the limb is no longer present. It is not purely psychological.

A. Mild erythema B. Serosanguineous drainage C. Fever D. Warmth

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.

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A nurse is caring for a client who has multiple long bone fractures caused by a motor-vehicle crash that happened 24 hr ago. The client tells the nurse he is short of breath and experiencing chest pain. The nurse should assess the client further for which of the following potential complications?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a severe gangrenous infection of the right lower extremity. The nurse should plan preoperative teaching based on the possibility of which of the following amputation procedures?

Correct Answer is A

Explanation

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 assessing the elastic bandage on the stump of a client who had a right below-the knee amputation. Which of the following findings should the nurse identify as a complication?

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A nurse is caring for a client who has a fractured tibia as a result of a fall. The client's x-ray shows that the bone is splintered into several pieces around the shaft. The nurse should identify that the client has which of the following types of fractures?