The nurse is continuing to care for the child.
For each statement by the parent, click to specify if the statement reflects an understanding or indicates a need for reinforcement of the discharge teaching.
"We should notify the provider if the cast becomes loose over time."
"It is important that our child avoids placing anything inside the cast."
"We should expect the swelling and tingling to worsen before it gets better."
"We need to be very careful about how we handle the cast for the first 2 days while it dries."
"We should prop the casted arm on pillows for the next 24 hours."
The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}
Rationale:
- "We should notify the provider if the cast becomes loose over time." A loose cast may no longer immobilize the fracture effectively and can allow excessive movement. It may also rub the skin, increasing the risk of irritation or breakdown.
- "It is important that our child avoids placing anything inside the cast." This statement reflects understanding because inserting objects inside the cast can break the skin and introduce bacteria, leading to infection. It may also damage the padding and compromise skin protection.
- "We should expect the swelling and tingling to worsen before it gets better." This statement needs reinforcement because worsening swelling and tingling can indicate early signs of compartment syndrome. These symptoms are not normal and should prompt immediate medical attention.
- "We need to be very careful about how we handle the cast for the first 2 days while it dries." This shows understanding because a plaster cast takes 24 to 48 hours to fully dry. Improper handling can cause pressure indentations, leading to skin damage and poor cast integrity
- "We should prop the casted arm on pillows for the next 24 hours." Elevating the limb helps reduce swelling and pain by improving venous return. Keeping the casted arm elevated is a standard part of cast care teaching after an injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Hyperkalemia: Furosemide is a loop diuretic that promotes potassium excretion, which can lead to hypokalemia, not hyperkalemia. Monitoring for low potassium is important, but hyperkalemia is not a primary concern with these medications.
B. Hypoglycemia: Neither furosemide nor gentamicin directly affects blood glucose levels. Hypoglycemia is not a typical complication of these medications.
C. Ototoxicity: Gentamicin, an aminoglycoside antibiotic, and furosemide, a loop diuretic, can both cause ototoxicity, which may result in tinnitus, hearing loss, or balance disturbances. Monitoring for auditory changes is essential when these medications are used concurrently.
D. Liver toxicity: These medications are not primarily hepatotoxic. Liver function monitoring is not a routine requirement for furosemide or gentamicin unless there are other predisposing conditions.
Correct Answer is A
Explanation
Rationale:
A. "You have the right to decide who receives information.": Clients have the legal and ethical right to confidentiality regarding their medical care under HIPAA and patient privacy regulations. Respecting the client’s decision about who can receive health information reinforces autonomy and ensures that the nurse supports the client’s rights in healthcare decision-making.
B. "Your partner can be a great source of support for you at this time.": While acknowledging the potential benefits of support is empathetic, this statement does not address the client’s request for privacy. It may inadvertently pressure the client to share information, which could violate confidentiality and autonomy.
C. "Is there a reason you don't want your partner to know about your procedure?": Asking for justification may make the client feel challenged or judged. The client is not required to explain their choice, and pressing for reasons can undermine trust and respect for their privacy.
D. "The provider will be tactful when talking to your partner.": This statement assumes the provider will communicate with the partner and disregards the client’s expressed wishes. It could lead to disclosure against the client’s consent, violating confidentiality and patient rights.
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