A nurse is reinforcing teaching with the parent of a preschooler who has a hip fracture and is in a spica cast. Which of the following findings should the nurse identify as an indication of infection?
Hot spot on the cast
General edema of the toes
Pruritus under the cast
Pain at the fracture site
The Correct Answer is A
A. A hot spot on the cast may indicate localized infection. When the skin underneath the cast becomes infected, it can lead to localized warmth, tenderness, and redness. It is important to promptly assess and address the situation, as infections can progress quickly in these circumstances.
B. General edema of the toes is a common response to immobilization and injury, but it does not specifically indicate infection. It is more likely related to inflammation or impaired circulation from the cast.
C. Pruritus (itching) under the cast can occur due to the skin's reaction to the cast material, dryness, or moisture accumulation, but it is not necessarily an indication of infection.
D. Pain at the fracture site is common and expected as the fracture heals, but it alone is not an indication of infection unless associated with other symptoms like fever, warmth, or drainage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Lansoprazole is a proton pump inhibitor (PPI) that is most effective when taken 30 minutes before meals, as it works by reducing stomach acid production in response to food intake.
B. Lansoprazole capsules should not be placed under the tongue, as they are intended to be swallowed whole to ensure proper absorption.
C. Lansoprazole is typically prescribed once daily, not four times per day, unless otherwise directed by the healthcare provider.
D. Chewing the capsule would interfere with its controlled-release formulation, leading to reduced effectiveness. The capsule should be swallowed whole.
Correct Answer is B
Explanation
A. Passive range-of-motion exercises should be performed to prevent complications like contractures, but they should be done as ordered by the provider, not automatically every 2 hours.
B. Applying protective padding to the end of the pin sites helps prevent pressure injuries and irritation, which is a key part of maintaining skin integrity and preventing infection.
C. There is no indication that fiber intake should be reduced. In fact, a high-fiber diet is encouraged to prevent constipation, which is a common complication for immobile patients.
D. The traction weights should not be lifted off the floor, as this could interfere with the traction setup and the healing process. Traction should be maintained properly to align and stabilize the fracture.
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