The nurse is caring for a client with external fixation of the tibia. Which of the following would the nurse include in the plan of care?
Removing and applying the fixator for showers.
Documenting pin site assessment and care.
Encouraging the patient to lie prone several times per day.
Turning the patient every 3 hours.
The Correct Answer is B
A. Removing and applying the fixator for showers is not appropriate. The external fixator should not be removed by the nurse without proper medical guidance. Showers should be managed in a way that prevents the fixator from becoming wet or contaminated.
B. Documenting pin site assessment and care is essential for clients with external fixation. The nurse should regularly assess pin sites for signs of infection (e.g., redness, swelling, drainage) and ensure proper care is provided to prevent complications.
C. Encouraging the patient to lie prone several times per day may not be necessary or appropriate unless specifically ordered by the provider. The patient’s positioning should be based on comfort and the provider’s instructions to avoid strain on the injured limb.
D. Turning the patient every 3 hours is a general nursing practice for preventing pressure ulcers, but it is not specific to the care of a client with external fixation. The focus should be on protecting the fixator and ensuring the limb is properly supported.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["75"]
Explanation
- Total volume: 1800 mL
- Infusion time: 24 hours
- Calculation: 1800 mL / 24 hours = 75 mL/hour
Therefore, the IV pump should be set to deliver 75 mL/hr.
Correct Answer is A
Explanation
A. 50% Dextrose in Water (D50W) IV push is the most appropriate intervention for a client with a blood glucose level of 30 mg/dL, indicating severe hypoglycemia. The rapid administration of D50W will quickly raise the blood glucose level and help restore consciousness.
B. Insulin Regular IV push would lower the blood glucose level, which is not appropriate in this situation where the client is hypoglycemic.
C. 0.9% sodium chloride infusion is a general fluid replacement solution, but it will not address the client's low blood glucose level.
D. 5% Dextrose continuous IV infusion is typically used for maintenance, but it would not act as quickly as D50W to correct severe hypoglycemia in an unconscious patient.
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