Try Naxlex NCLEX-RN (Free-Trial)

A nurse is caring for an adolescent client who has a newly applied fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take?

A.

Provide reassurance to the client and parents.

B.

Perform a neurovascular assessment.

C.

Apply an ice pack to the casted leg

D.

Explain the discharge instructions to the client and parents.

Answer and Explanation

The Correct Answer is B

A. Provide reassurance to the client and parents: While reassurance is important, it is not the priority action when caring for an adolescent client with a newly applied fiberglass cast for a fractured tibia. Ensuring adequate neurovascular status is critical to prevent complications associated with impaired circulation or nerve function.
B. Perform a neurovascular assessment: This is the correct action and the priority when caring for a client with a newly applied cast. The nurse should assess the client's neurovascular status by evaluating circulation, sensation, and movement distal to the casted limb. Changes in color, temperature, sensation, or movement could indicate impaired circulation or nerve function, which require immediate intervention to prevent complications such as compartment syndrome.
C. Apply an ice pack to the casted leg: While applying ice may help reduce swelling and discomfort, it is not the priority action when caring for a client with a newly applied cast. Additionally, applying ice directly to the cast may not effectively reach the skin and underlying tissues, potentially causing discomfort without providing significant benefit.
D. Explain the discharge instructions to the client and parents: Providing discharge instructions is important for client education, but it is not the priority action immediately after applying a cast. Ensuring the client's safety and well-being by performing a neurovascular assessment takes precedence to identify and address any potential complications associated with the cast.
 


Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Free Nursing Study Resources

Related Questions

Correct Answer is ["5.6"]

Explanation

Let's calculate the amount of amoxicillin suspension the nurse should administer.

Steps:

  1. Convert toddler's weight to kilograms (kg):
    • Weight (kg) = Weight (lb) / 2.2 lb/kg
    • Weight (kg) = 33 lb / 2.2 lb/kg
    • Weight (kg) ≈ 15 kg
  2. Calculate total daily dose of amoxicillin:
    • Total dose (mg/day) = Dose per kg/day x Weight (kg)
    • Total dose (mg/day) = 30 mg/kg/day x 15 kg
    • Total dose (mg/day) = 450 mg/day
  3. Calculate amoxicillin needed per dose (since it's given every 12 hours, we need half the daily dose):
    • Dose per administration (mg) = Total daily dose (mg/day) / Number of doses/day
    • Dose per administration (mg) = 450 mg/day / 2 doses/day
    • Dose per administration (mg) = 225 mg
  4. Calculate the volume (mL) of suspension based on the concentration:
    • Concentration (mg/mL) = Amount of amoxicillin (mg) / Volume (mL)
    • We need to rearrange the formula to find the volume (mL): Volume (mL) = Amount of amoxicillin (mg) / Concentration (mg/mL)
    • Known values:
      • Amount of amoxicillin (mg) = 225 mg (calculated in step 3)
      • Concentration (mg/mL) = 200 mg/5 mL (from available suspension)
    • Volume (mL) = 225 mg / (200 mg/5 mL)
    • To simplify the calculation, divide both numerator and denominator by 25: Volume (mL) = (225 mg / 25) / (200 mg/5 mL / 25) Volume (mL) = 9 mL / 4 mL/mL. Pay attention here, dividing by mL/mL is the same as multiplying by 1)
    • Volume (mL) = 9 mL
  5. Round the answer to the nearest tenth:
    • Volume (mL) ≈ 5.6 mL

Therefore, the nurse should administer approximately 5.6 mL of amoxicillin suspension per dose.

Correct Answer is C

Explanation

A. This statement reflects guilt or concern over potential harm to the child, which may be distressing but does not specifically indicate symptoms of PTSD related to combat exposure.
B. This statement describes nightmares or intrusive thoughts related to traumatic events, which are common symptoms of PTSD. The content of the dreams suggests re-experiencing of traumatic events, which is characteristic of PTSD.
C. This statement reflects hypervigilance and paranoia, common symptoms of PTSD. The client's behavior of checking rooms for potential threats indicates a heightened state of arousal and persistent fear related to past combat experiences.
D. While involvement in combat and actions such as killing enemy soldiers may contribute to the development of PTSD, this statement does not directly reflect symptoms of the disorder. Instead, it describes a specific event from the client's military experience. Symptoms of PTSD typically involve re-experiencing, avoidance, negative changes in mood and cognition, and hyperarousal.

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Register