A. Crying when the arm is examined is an expected response in a toddler with a painful fracture and does not by itself indicate abuse.
B. A single injury alone is not necessarily suspicious for abuse; accidental injuries can cause one fracture.
C. Being brought in promptly (30 minutes after injury) suggests appropriate parental concern and is not a red flag.
D. Spiral fractures typically result from a twisting motion and are uncommon from a simple fall off a couch. When the history provided by the parents does not match the type of injury, this inconsistency is a strong indication of possible abuse.

A. The nurse should never loosen knots or adjust the traction without a provider’s prescription, as this can compromise alignment and healing.
B. Bony prominences should be checked at least every 8 hr (not every 12 hr) to prevent skin breakdown and pressure injuries.
C. Povidone-iodine is no longer recommended for pin site care because it can damage tissue; chlorhexidine or sterile saline is typically used per protocol.
D. Ensuring the weights hang freely maintains the continuous pulling force necessary for proper alignment and healing of the fracture, making this the correct action.

A. Uneven cast drying can cause warm spots, but this is expected only in the first few hours after application; a set, dry cast should not feel warm.
B. Pressure from the cast can cause pain, skin breakdown, or impaired circulation, but it does not usually produce warmth.
C. A localized warm area on a dry cast can indicate infection underneath the cast, often accompanied by odor, drainage, or client complaints of pain.
D. Poor circulation is associated with coolness, pallor, or numbness distal to the cast, not warmth.

A. Methotrexate can cause renal toxicity. Encouraging fluid intake of at least 2 L/day helps prevent kidney damage and promotes drug excretion, making this the correct instruction.
B. Commercial mouthwashes often contain alcohol, which can worsen methotrexate-induced stomatitis. Instead, clients should use a soft toothbrush and nonalcoholic rinses.
C. Methotrexate for rheumatoid arthritis is taken weekly, not daily. Daily dosing can lead to severe toxicity.
D. Foods high in vitamin K affect warfarin therapy, not methotrexate. There is no restriction on vitamin K with methotrexate use.

A. Buck’s traction is not intended to support active movement of the extremity; movement is limited to maintain alignment.
B. Unlike skeletal traction, Buck’s traction does not provide fracture reduction but is used temporarily until surgery.
C. Pin alignment is not relevant because Buck’s traction is a skin traction, not a skeletal traction with pins.
D. Buck’s traction is primarily used preoperatively to immobilize the limb and relieve muscle spasms associated with hip fractures, making this the correct outcome.

A. Long-term glucocorticoid therapy accelerates bone resorption, decreases bone formation, and reduces calcium absorption, all of which contribute to osteoporosis.
B. NSAIDs are not associated with bone loss; they are more commonly used for pain and inflammation management.
C. Oral antidiabetic medications primarily affect blood glucose regulation, not bone density.
D. Cardiac glycosides (e.g., digoxin) affect heart function but are not linked to osteoporosis development.

A. A moderate intake of high-fiber foods is appropriate because excessive fiber can interfere with calcium absorption, but moderation supports overall health.
B. Reducing sodium intake helps decrease calcium loss through the kidneys, which is beneficial for osteoporosis prevention.
C. Limiting caffeine is recommended because excessive caffeine increases calcium excretion and reduces calcium absorption.
D. Vitamin E is not a nutrient associated with bone health. The focus should be on calcium and vitamin D, not vitamin E, so this statement requires clarification.

A. Allopurinol can be taken with or after meals to reduce gastrointestinal upset; taking it on an empty stomach is not necessary.
B. Fever is not an expected side effect of allopurinol and may indicate an adverse reaction or infection.
C. Drinking at least 3 quarts (≈3 liters) of water per day helps prevent kidney stones, a common complication of uric acid buildup, demonstrating correct understanding.
D. A rash can indicate a serious hypersensitivity reaction to allopurinol; the client should stop the medication and contact the provider immediately, not self-treat with an antihistamine.

A. The first action after finding a client on the floor is to assess for injuries and determine the extent of any harm before moving the client.
B. Assisting the client back into bed without assessing for injury could worsen a fracture or other trauma; applying restraints is inappropriate and unsafe.
C. Sedating the client without assessment is unsafe and not indicated.
D. Calling the family before assessing the client does not address the immediate safety and health needs.

A. Fat embolism syndrome typically presents with respiratory distress, confusion, and petechial rash, not localized tingling and severe pain.
B. Pulmonary embolism involves sudden shortness of breath, chest pain, and possible hemoptysis, not isolated leg symptoms.
C. Acute compartment syndrome is characterized by severe pain, tingling, numbness, and sometimes pallor or paralysis in the affected extremity. These symptoms result from increased pressure within a muscle compartment, making this the correct complication.
D. Osteomyelitis involves infection of the bone, presenting with localized pain, redness, and fever, but tingling is not a classic early sign.