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The nurse is continuing to care for the child.

Exhibits

Complete the following sentence by using the lists of options.

The child is at highest risk for developing

as evidenced by the child's .
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Rationale for Correct Choices:

  • Compartment Syndrome: Compartment syndrome is a limb-threatening condition that occurs when increased pressure within a muscle compartment impairs circulation and nerve function. The child has a nondisplaced fracture of both the radius and ulna, along with edema, ecchymosis, and fingers that are cool to touch, all of which are early signs of compromised perfusion.
  • Tingling Sensation: Tingling (paresthesia) is an early neurological sign of impaired sensory function often seen in the early stages of compartment syndrome. This child verbalizes a mild tingling in the fingers, which indicates nerve compression due to increased pressure within the forearm compartments.

Rationale for Incorrect Choices

  • Paresthesia: Tingling is the hallmark symptom of paresthesia, but paresthesia is a symptom, not a disease process. The nurse must determine the underlying cause of the altered sensation, which in this situation is likely compartment syndrome.
  • Deep Vein Thrombosis (DVT): DVT typically presents with unilateral leg swelling, warmth, pain, and sometimes redness—not forearm injury symptoms. The child has a forearm fracture and bruises on the lower extremities in different healing stages, but there's no localized swelling, erythema, or immobility in the legs to support a DVT diagnosis.
  • Pain Level: A pain score of 4 out of 10 is not severe enough to support compartment syndrome or any acute vascular crisis alone. Pain that is out of proportion to the injury and unrelieved by medication would raise concern.
  • Mobility: The child is ambulatory and able to move their fingers and limbs, which reduces the likelihood of venous stasis a major risk factor for DVT. In the absence of prolonged immobility or systemic hypercoagulability, there is minimal reason to suspect a thrombotic event based on mobility alone.


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Related Questions

Correct Answer is C

Explanation

Rationale:

A. Penicillin: Saw palmetto does not interfere with antibiotic action or metabolism. No significant pharmacodynamic or pharmacokinetic interaction exists between penicillin and saw palmetto.

B. Zolpidem: While both may cause some central nervous system effects, there is no established adverse interaction between zolpidem and saw palmetto. Co-administration is generally not contraindicated.

C. Clopidogrel: Saw palmetto has antiplatelet properties and can potentiate the effects of clopidogrel, increasing the risk of bleeding. Clients taking both may face elevated risk of gastrointestinal or intracranial hemorrhage.

D. Ipratropium: Ipratropium is an anticholinergic agent used primarily for respiratory conditions. It does not have a known interaction with saw palmetto, and their pharmacologic mechanisms do not overlap.

Correct Answer is C

Explanation

Rationale:

A. "Placement of the catheter is confirmed by a CT scan.": Catheter placement is typically confirmed by a chest X-ray, not a CT scan, to verify correct positioning and rule out complications such as pneumothorax. CT imaging is not routine for this purpose.

B. "You will be under general anesthesia for this procedure.": Placement of a nontunneled percutaneous central line is usually done under local anesthesia with possible mild sedation. General anesthesia is not required for this relatively short and minimally invasive procedure.

C. "The provider will wear a mask while performing the procedure.": A mask, along with sterile gloves, gown, and drape, is worn to maintain sterile technique and reduce the risk of catheter-related bloodstream infections. This is standard protocol during central line insertion.

D. "Your head will be elevated as high as possible while the catheter is inserted.": The client is usually placed in the Trendelenburg position (head down) during catheter insertion to distend neck veins and reduce the risk of air embolism—not in a high head-elevated position.

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