Following a fractured left tibia, which necessitated placement of long leg cast, a client is using crutches to ambulate. During an orthopedic follow-up visit, a client reports to the nurse having difficulty managing the crutches. Which assessment should the nurse perform?

Measure capillary refill time.

Palpate for dependent edema.

Determine degree of skin elasticity.

Note hand and forearm strength.

Answer and Explanation

The Correct Answer is D

A.   Capillary refill time assessment is more relevant for circulatory status and would not directly address the client's difficulty with crutch management.
B.   Palpating for dependent edema would not provide information directly related to the client's ability to use crutches.

C.   Assessing skin elasticity is not directly related to the client's ability to manage crutches.
D.   Strength in the hands and forearms is essential for proper crutch use, as these muscles bear much of the weight while ambulating with crutches.

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Correct Answer is C

Explanation

A. Normalized electrolytes are important but do not specifically indicate gastrointestinal motility.
B. Decreased nausea can be a sign of improvement but is less specific than passing flatus.
C. Passing flatus indicates that there is movement of gas through the intestines, which is a direct sign of returning gastrointestinal motility.
D. Return of appetite can occur for various reasons and is not as direct an indicator of GI motility as passing flatus.

A. Regression. B. Suppression. C. Compensation. D. Sublimation.

Correct Answer is D

Explanation

A. Regression involves reverting to behaviors from an earlier developmental stage, which is not demonstrated in this scenario.
B. Suppression is the conscious decision to delay paying attention to a thought or feeling, which is not evident here.
C. Compensation involves making up for a perceived deficiency by emphasizing another trait or skill, which does not apply to this situation.
D. Sublimation is the process of channeling unacceptable impulses into socially acceptable activities. By vigorously working on the leather belt, the client is redirecting potentially aggressive energy into a constructive and creative outlet.

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Following a fractured left tibia, which necessitated placement of long leg cast, a client is using crutches to ambulate. During an orthopedic follow-up visit, a client reports to the nurse having difficulty managing the crutches. Which assessment should the nurse perform?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is admitted for medical management of a bowel obstruction. The drainage volume from the nasogastric tube over the last 12 hours is 300 milliliters. Which assessment finding provides the earliest indication that the client is experiencing gastrointestinal motility?

Correct Answer is C

Explanation

A client who is participating in an anger management assignment asks to make a leather belt in occupational therapy. The client begins pounding the leather vigorously with a mallet to imprint designs on the belt. Which defense mechanism is the client using?

Correct Answer is D

Explanation

The psychiatric nurse is caring for clients on an adolescent unit. Which client requires the nurse's immediate attention?

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Patient Data Exhibits What order(s) should the nurse anticipate being prescribed after an update is reported to the healthcare providers? Select all that apply.

Exhibits Nursing actions: Indicated/contraindicated/non-urgent