The nurse is continuing to care for the child.
Elevate the affected forearm with pillows.
Administer Ibuprofen 200 mg PO.
Place a non adherent dressing on the right knee abrasion.
Review cast care instructions with the child's parents.
Explain the cast application procedure to the child.
Apply ice packs to the fingers and along the right forearm.
Correct Answer : A,B,F
Rationale:
A. Elevate the affected forearm with pillows: Elevation helps reduce swelling and promotes venous return, which is critical in the immediate management of a fracture to prevent complications such as increased edema or impaired circulation.
B. Administer Ibuprofen 200 mg PO: The child reports pain at a level of 5, meeting the prescription threshold. Administering analgesia promptly helps manage discomfort and supports cooperation with further interventions, such as casting.
C. Place a nonadherent dressing on the right knee abrasion: While wound care is important, the abrasion is minor and not the most urgent concern. Prioritization focuses on the fractured limb and pain management.
D. Review cast care instructions with the child's parents: Education is important but is not the immediate priority before the cast is applied. It can be provided after the child is stabilized and pain is managed.
E. Explain the cast application procedure to the child: While preparing the child psychologically is important, immediate interventions to reduce pain and swelling take precedence over anticipatory teaching.
F. Apply ice packs to the fingers and along the right forearm: Ice helps reduce swelling and pain in the acute phase of the fracture. Applying ice in combination with elevation supports circulation and comfort while awaiting casting.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","E"]
Explanation
Rationale:
A. Limit visitors to 30 min per day: Limiting the duration of visitors helps minimize radiation exposure to others. Only short, necessary visits are allowed, and visitors are advised to maintain a safe distance to reduce the cumulative radiation dose received during contact with the client.
B. Place the client in a semi-private room: Clients with sealed internal radiation implants should always be placed in a private room to protect others from unnecessary radiation exposure. A semi-private room would increase the risk of exposing other patients to radiation.
C. Instruct visitors who are pregnant to remain 3 feet from the client: Pregnant visitors should be instructed not to enter the client’s room at all because of the high sensitivity of the fetus to radiation exposure.
D. Wear a lead apron when providing care: The nurse must wear a lead apron while providing direct care to shield against radiation exposure. The nurse should also stand at the client’s side rather than directly in front of or behind the radiation source to minimize exposure intensity.
E. Close the door to the client’s room: Keeping the client’s door closed helps contain the radiation within the room, preventing unnecessary exposure to staff and other clients in nearby areas. It is part of the standard protective measures for clients undergoing internal radiation therapy.
Correct Answer is A
Explanation
Rationale:
A. Advise the client to wait 1 hr before showering or swimming: Testosterone gel should be allowed to fully absorb into the skin before washing or swimming, typically waiting at least 1 hour. This ensures optimal absorption and therapeutic effect.
B. Instruct the client to have his testosterone checked in 1 week: Testosterone levels are generally evaluated after several weeks of therapy to assess effectiveness, not after just one week.
C. Wear clean gloves to apply the gel: The client should apply the medication themselves using clean, dry hands. The nurse should wear gloves only if assisting to prevent unintentional hormone absorption.
D. Apply the gel to the client's genital region: Testosterone gel should not be applied to the genitals due to increased absorption risk and skin irritation. Recommended sites include shoulders, upper arms, or abdomen.
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