The nurse is continuing to care for the child.
Administer Ibuprofen 200 mg PO.
Elevate the affected forearm with pillows.
Place a nonadherent dressing on the right knee abrasion.
Review cast care instructions with the child's parents.
Apply ice packs to the fingers and along the right forearm.
Explain the cast application procedure to the child.
Correct Answer : A,B,E
Rationale:
A. Administer Ibuprofen 200 mg PO: The child reports a pain score of 5/10 and is requesting pain medication. The provider has prescribed ibuprofen PRN for this level of pain. Prompt administration supports comfort and reduces inflammation associated with fracture and swelling.
B. Elevate the affected forearm with pillows: Elevation helps reduce edema by promoting venous return and lymphatic drainage. Given the child's worsening edema in the forearm and fingers, this is a priority to minimize complications like compartment syndrome.
C. Place a nonadherent dressing on the right knee abrasion: Although dressing the abrasion is a reasonable intervention, it is not a priority at this stage. The abrasion is not actively bleeding or infected, so attention should remain on managing neurovascular risk and pain.
D. Review cast care instructions with the child's parents: This is an important educational step, but it is not a current priority since the cast has not yet been applied. Priority actions should focus on pain, swelling, and circulation while awaiting casting.
E. Apply ice packs to the fingers and along the right forearm: Ice helps manage pain and inflammation by vasoconstriction, limiting fluid accumulation in tissues. Applying it early post-injury is crucial to controlling swelling in a fractured limb.
F. Explain the cast application procedure to the child: Preparing the child for a future procedure is helpful but not immediately necessary. At this point, pain control and reduction of swelling take precedence to prevent complications and stabilize the injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E"]
Explanation
Rationale:
A. Polydipsia: Polydipsia, or excessive thirst, is commonly associated with hyperglycemia due to osmotic diuresis caused by high blood glucose levels. It is not a typical feature of hypoglycemia.
B. Tremors: Tremors are a hallmark symptom of hypoglycemia. They result from the body's adrenergic (sympathetic) response to low blood glucose levels, which triggers the release of epinephrine to raise glucose.
C. Acetone breath odor: A fruity or acetone breath odor is associated with diabetic ketoacidosis, a complication of hyperglycemia, not hypoglycemia. It indicates ketone buildup due to fat metabolism in the absence of insulin.
D. Inability to concentrate: Cognitive impairment, such as confusion or difficulty concentrating, is a neurological symptom of hypoglycemia. The brain relies heavily on glucose, and low levels affect its function quickly.
E. Diaphoresis: Sweating is a common autonomic symptom of hypoglycemia due to activation of the sympathetic nervous system. It often occurs early in a hypoglycemic episode and is a critical sign to monitor.
Correct Answer is D
Explanation
Rationale:
A. The client advances the walker and takes a step towards it: This is the correct technique for using a walker. The client should move the walker a short distance ahead, then step into it one foot at a time, maintaining balance and stability throughout the motion.
B. The client grasps the walker by the hand grips on the upper bars: Holding the walker by its designated hand grips is safe and appropriate. This ensures proper control of the device and minimizes the risk of slipping or tipping.
C. The client lifts the walker as it is moved forward: Walkers should be lifted and placed rather than dragged to maintain balance and prevent tripping. This action demonstrates proper use and helps maintain floor contact with all legs of the walker.
D. The client takes multiple steps while holding the walker: Taking multiple steps without first advancing the walker compromises balance and increases the risk of falling. The correct method involves moving the walker first, then taking one step at a time toward it.
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