A nurse is reinforcing teaching with a client who is to have plaster cast applied to his right arm. Which of the following information should the nurse include the teaching?
The client should use a hair dryer on a warm setting to relieve itching inside the cast.
The client can shower with the cast after 24 hr.
The client’s extremity should be elevated after the cast applied.
The client should keep the cast covered until it is dry
The Correct Answer is C
A) "The client should use a hair dryer on a warm setting to relieve itching inside the cast.": Using a hair dryer on a warm setting to relieve itching inside the cast is not recommended because it could potentially lead to burns or skin irritation. The client should avoid inserting objects inside the cast to scratch, as this could damage the skin or cause an infection.
B) "The client can shower with the cast after 24 hr.": A plaster cast is not waterproof, and the client should avoid getting it wet. Although the cast may feel dry on the outside after 24 hours, it typically takes about 48 hours or longer for a plaster cast to fully dry and harden. Showering with a plaster cast is not safe, as moisture could cause skin irritation or lead to the development of sores or infection.
C) "The client’s extremity should be elevated after the cast is applied.": Elevating the extremity after a cast is applied is a key teaching point to help reduce swelling and improve circulation. This is especially important during the first 24 to 48 hours after cast application. Elevation helps to prevent or manage swelling, which can be a common complication after an injury and cast application.
D) "The client should keep the cast covered until it is dry.": While it is important to keep a cast clean and dry during the drying process, the cast should not be covered with plastic or other materials that could trap moisture. The cast needs air circulation to dry properly, and covering it could lead to the cast becoming too moist, increasing the risk of skin issues or infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","E"]
Explanation
A. Chronic health condition: The client has a history of Parkinson’s disease and anxiety, which are relevant but not immediate concerns. Chronic conditions require long-term management rather than urgent intervention.
B. Current level of consciousness: The client is restless and not following commands, which may indicate hypoxia, worsening infection, or sepsis. A change in mental status is a critical finding requiring immediate evaluation.
C. Oxygen saturation level: The oxygen saturation is 89% on room air, which is below the normal range (≥95%). This suggests respiratory compromise, likely due to pneumonia, requiring urgent oxygen support.
D. Heart rate: The client has a heart rate of 104/min, which is mildly elevated and expected due to fever and respiratory distress. However, it is not the most critical concern compared to respiratory distress and altered mental status.
E. Respiratory rate: The respiratory rate is 30/min, indicating tachypnea and increased work of breathing, suggesting respiratory distress or impending respiratory failure. This requires immediate intervention.
F. Tremors: Tremors are a common finding in Parkinson’s disease and do not require immediate intervention.
Correct Answer is A
Explanation
A) "I will get you information about some head-covering options."
This response acknowledges the client's concern about hair loss and provides a supportive and proactive solution. Many chemotherapy clients experience hair loss, and offering resources for head coverings shows empathy while helping them cope with the anticipated changes in appearance. It demonstrates the nurse's willingness to assist the client with emotional and physical challenges related to treatment.
B) "Let’s discuss this when we have more time."
Delaying the discussion about hair loss is not ideal. It dismisses the client’s current concern and may make the client feel like their feelings are not a priority. Hair loss can be a significant emotional challenge, and the nurse should address it in a timely and compassionate manner rather than postponing the conversation.
C) "I can’t imagine how difficult it would be to lose my hair."
While this response is empathetic, it focuses on the nurse's feelings instead of addressing the client's concern. It is important to maintain a client-centered approach and focus on the client's needs. The nurse should offer concrete support or information, such as head-covering options, rather than expressing personal emotions that may not be helpful to the client.
D) "I wouldn’t worry about this right now. Let's focus on your chemotherapy."
This response dismisses the client's concern about hair loss, which can be a significant issue for many clients starting chemotherapy. Minimizing the concern or suggesting it is not worth discussing at this time may make the client feel unheard or undervalued. It’s important to acknowledge the client’s worries and provide support for them to manage the emotional impacts of chemotherapy.
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