The nurse is preparing a client who had a below-the-knee (BKA) amputation for discharge to home. Which recommendation(s) should the nurse provide this client? (Select all that apply.)
Inspect skin for redness.
Use a residual limb shrinker.
Avoid range of motion exercises.
Apply alcohol to the residual limb after bathing.
Correct Answer : A,B
The correct answer is a. Inspect skin for redness and b. Use a residual limb shrinker.
Choice A rationale:
Inspecting the skin for redness is crucial to identify any signs of infection or pressure sores early. Redness can indicate irritation or the beginning of a pressure ulcer, which needs to be addressed promptly to prevent further complications.
Choice B rationale:
Using a residual limb shrinker helps to reduce swelling and shape the residual limb for prosthetic fitting. It also helps in managing pain and promoting healing by providing consistent compression.
Choice C rationale:
Avoiding range of motion exercises is incorrect. Range of motion exercises are essential to maintain joint flexibility and prevent contractures, which can hinder the use of a prosthetic limb.
Choice D rationale:
Applying alcohol to the residual limb after bathing is not recommended. Alcohol can dry out the skin and cause irritation, which can lead to skin breakdown and infection. Instead, the residual limb should be kept clean and moisturized with appropriate skin care products.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","F"]
Explanation
A) Cerebral edema: Brain injury or trauma can lead to swelling and increased intracranial pressure.
B) Correct- Near- drowning causes acute asphyxia because it prevents the person from breathing in oxygen and exhaling carbon dioxide. Asphyxia is a condition where the body is deprived of oxygen, which can lead to loss of consciousness, brain injury, or death.
C) Incorrect- Hypertension is not a common complication following near-drowning. The focus should be on potential brain injuries and respiratory distress.
D) Correct- Near-drowning can lead to aspiration of water or other substances, which can result in respiratory distress.
E) Incorrect- hyperthermia is not likely to occur in this case because the child was exposed to cold water.
F) Correct- Head trauma can lead to bleeding within the brain, such as a subdural hemorrhage.
Correct Answer is A
Explanation
A) Correct- this can help them structure their time, reduce boredom and anxiety, and increase their sense of control and achievement. This can also foster social interaction and engagement with the staff and peers. A schedule of planned daily activities is consistent with the principles of psychosocial rehabilitation, which is an evidence-based approach for people with schizophrenia.
B) Incorrect- this may be too challenging or stressful for the client, especially if they have cognitive impairments or negative symptoms.
C) Incorrect- may expose them to unfamiliar or unpredictable situations that could trigger or worsen their psychotic symptoms.
D) Incorrect- it is not an intervention that directly addresses the client's current problem of social isolation.
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