The nurse is caring for a patient who has a pelvic fracture and an external fixation device.
How should the nurse perform assessment of pressure areas and provide skin care to the patient's back and sacrum?

Have the patient lift the back and buttocks using a trapeze.

Ask the patient to turn to the side independently.

Roll the patient over to the side by pushing on the patient's hip.

Defer back assessment until the patient is ambulatory.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Having the patient lift their back and buttocks using a trapeze allows for proper assessment of pressure areas and skin care. This technique reduces the risk of further injury or discomfort and provides better access for the nurse to assess the skin condition.

Choice B rationale

Asking the patient to turn to the side independently may not be feasible for a patient with a pelvic fracture. This method can cause pain and risk further injury, making it an unsuitable choice for assessing pressure areas.

Choice C rationale

Rolling the patient over to the side by pushing on the patient's hip is not recommended as it can exacerbate the injury and cause pain. This method is not appropriate for patients with pelvic fractures.

Choice D rationale

Deferring back assessment until the patient is ambulatory is not a safe practice. Pressure areas should be regularly assessed to prevent skin breakdown and complications, even if the patient is not yet ambulatory.

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Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A rationale

Jaundice is not commonly associated with Crohn's disease; it is more related to liver or gallbladder issues.

Choice B rationale

Hypertension is not a common symptom of Crohn's disease. It is generally associated with other conditions such as cardiovascular disease.

Choice C rationale

Abdominal pain and cramping are hallmark symptoms of Crohn's disease due to inflammation in the gastrointestinal tract.

Choice D rationale

Weight loss, rather than weight gain, is typically associated with Crohn's disease due to malabsorption and chronic inflammation.

A. Infuse 10 percent dextrose and water if the solution runs out. B. Shake the TPN bag with fat emulsion if precipitate is present. C. Maintain TPN infusion rate when behind schedule. D. Keep the TPN refrigerated when not in use.

Correct Answer is ["A","D"]

Explanation

Choice A rationale

Infusing 10 percent dextrose and water prevents hypoglycemia if TPN is temporarily unavailable. This is a crucial step in maintaining the patient's blood sugar levels.

Choice B rationale

Shaking the TPN bag with fat emulsion can cause the emulsion to break, leading to potential complications. Fat emulsions should be mixed gently.

Choice C rationale

Maintaining the TPN infusion rate when behind schedule is incorrect as it can lead to rapid infusion and complications such as hyperglycemia and fluid overload.

Choice D rationale

Keeping the TPN refrigerated when not in use helps to maintain its stability and prevent bacterial contamination. Proper storage is essential for patient safety. .

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The nurse is caring for a patient who has a pelvic fracture and an external fixation device.How should the nurse perform assessment of pressure areas and provide skin care to the patient's back and sacrum?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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The nurse is caring for a patient who has a pelvic fracture and an external fixation device.
How should the nurse perform assessment of pressure areas and provide skin care to the patient's back and sacrum?