A nursing is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care?

Place the client in protective isolation.

Initiate the use of a PCA pump for pain control.

Keep the head of the bed at a 30° angle.

Reposition the client by log rolling every-4 hr.

Answer and Explanation

The Correct Answer is B

A: Placing the client in protective isolation is not necessary unless the client is immunocompromised or has another indication for isolation beyond the scoliosis repair.
B: A PCA (patient-controlled analgesia) pump allows the client to manage pain effectively by administering their own pain medication within prescribed limits, which is essential after the significant surgical intervention of scoliosis repair.
C: Keeping the head of the bed at a 30° angle is not specifically indicated for postoperative care following scoliosis repair with Harrington rod instrumentation. The position of the bed should be based on the client's comfort and specific postoperative orders.
D: Repositioning the client by log rolling every 4 hours is important to prevent complications such as pressure ulcers and to promote circulation, but it is not the priority intervention. Pain management postoperatively is crucial for client comfort, promoting mobility, and aiding in the recovery process.

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Correct Answer is D

Explanation

A. 1 plain baked potato is not a significant source of calcium.

B. 1 cup carrot strips do not provide a substantial amount of calcium.

C. ½ cup chopped chicken breast is a source of protein but is not high in calcium.

D. 3 oz canned salmon is one of the highest dietary sources of calcium. It is especially beneficial for individuals with osteoporosis because it contains not only calcium but also vitamin D, which helps with calcium absorption.

A. Cool extremities B. Decreased radial pulse C. Positive Chvostek's sign D. Positive Phalen's sign

Correct Answer is D

Explanation

A. Cool extremities are not typically associated with carpal tunnel syndrome. They may be a sign of poor circulation, but this is not a specific finding for carpal tunnel syndrome.

B. Decreased radial pulse is not a characteristic finding of carpal tunnel syndrome. It may indicate issues with blood flow to the hand but is not specific to this condition.

C. Positive Chvostek's sign is associated with hypocalcemia and involves facial muscle twitching when the facial nerve is tapped. It is not related to carpal tunnel syndrome.

D. Positive Phalen's sign is a characteristic finding in carpal tunnel syndrome. It involves tingling or numbness in the median nerve distribution (usually thumb, index, middle, and part of the ring finger) when the wrist is flexed for 60 seconds.

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A nursing is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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