A nurse is caring for a client who just had a left long-arm plaster cast applied after experiencing a musculoskeletal trauma. Which of the following actions should the nurse take?

Position the cast on a plastic-covered pillow.

Perform neurovascular checks every 2 hr.

Instruct the client to avoid moving the fingers on the left hand.

Touch the cast with the palms of the hands when moving the client.

Answer and Explanation

The Correct Answer is B

A) Position the cast on a plastic-covered pillow:
Positioning the cast on a plastic-covered pillow is not recommended because the plastic can trap moisture and heat, potentially affecting the cast's integrity as it dries. Instead, a soft, absorbent material should be used to support the cast.

B) Perform neurovascular checks every 2 hr:
Frequent neurovascular checks are essential to monitor for complications such as compartment syndrome, nerve damage, or impaired circulation. This action helps ensure that any changes in sensation, movement, or circulation are identified and addressed promptly.

C) Instruct the client to avoid moving the fingers on the left hand:
Encouraging the client to move their fingers is important to prevent stiffness and swelling and to promote circulation. Instructing the client to avoid moving their fingers is not appropriate and could lead to complications.

D) Touch the cast with the palms of the hands when moving the client:
Handling a wet plaster cast with the palms of the hands is correct to prevent indentations and pressure points that could cause skin irritation or pressure sores. However, this action is not as critical as performing frequent neurovascular checks to ensure the client's safety and monitor for complications.

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Correct Answer is C

Explanation

A) Administering risperidone 25 mg IM: Administering risperidone intramuscularly is generally used for managing severe psychotic symptoms and not typically indicated for acute panic attacks. Without prior prescription or proper assessment, this action may be unsafe and inappropriate.

B) Teaching the client how to perform guided imagery: Guided imagery is an effective technique for managing anxiety over the long term, but it is not suitable for immediate relief during a severe panic attack. The client may not be able to focus or learn new techniques when experiencing extreme distress.

C) Staying with the client until the panic attack subsides: Providing immediate emotional support and reassurance by staying with the client helps reduce the intensity of the panic attack. The nurse's presence can help the client feel safer and more secure, facilitating a return to a calmer state.

D) Encouraging the client to take quick, shallow breaths: Quick, shallow breaths can exacerbate hyperventilation and increase symptoms like dizziness and lightheadedness. It is more beneficial to encourage slow, deep breathing to help regulate breathing patterns and reduce panic symptoms.

A. Manic behavior B. Deep, labored respirations C. Bradycardia D. Cold intolerance

Correct Answer is A

Explanation

A) Manic behavior: Hyperthyroidism can lead to manic or hyperactive behavior due to increased metabolic rate and overstimulation of the nervous system. This may present as irritability, anxiety, or restlessness, making manic behavior a relevant manifestation in this condition.

B) Deep, labored respirations: Hyperthyroidism generally does not cause deep, labored respirations. Instead, it may lead to increased respiratory rate due to heightened metabolic activity. Deep, labored respirations are more indicative of respiratory or cardiac issues rather than hyperthyroidism.

C) Bradycardia: Hyperthyroidism usually causes tachycardia (elevated heart rate) rather than bradycardia (slow heart rate). Tachycardia is a common symptom due to the increased metabolic rate and sympathetic nervous system activity associated with hyperthyroidism.

D) Cold intolerance: Cold intolerance is more characteristic of hypothyroidism, where there is decreased metabolic activity and reduced heat production. Hyperthyroidism typically causes heat intolerance due to the increased metabolic rate and elevated body temperature.

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A nurse is caring for a client who just had a left long-arm plaster cast applied after experiencing a musculoskeletal trauma. Which of the following actions should the nurse take?

Nursing Test Bank

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