A 7-year-old client with a greenstick fracture of the forearm has a cast applied at the emergent care clinic.
Which home care information is most important for the practical nurse (PN) to reinforce with the parents?
Observe for any changes in nail bed color over the next 48 hours.
Allow the child to return to school after 1 day's rest at home.
Wrap the cast in a plastic bag when the child takes a shower.
Give the child a dose of acetaminophen as prescribed for pain.
The Correct Answer is A
Choice A rationale
Observing for any changes in nail bed color is crucial for assessing capillary refill and circulation distal to the cast. Pallor, cyanosis, or prolonged capillary refill (normal <2 seconds) can indicate impaired blood flow or nerve compression, signs of compartment syndrome, requiring immediate medical attention to prevent permanent tissue damage.
Choice B rationale
Allowing the child to return to school after only one day's rest is generally not advisable immediately after cast application. The initial 24-48 hours are critical for observing for swelling, neurovascular compromise, and managing pain. Rest and elevation are typically recommended to minimize edema formation.
Choice C rationale
Wrapping the cast in a plastic bag when the child takes a shower is important to prevent the cast from getting wet. A wet cast can soften, lose its supportive integrity, and promote skin maceration and infection underneath. Moisture can also lead to skin irritation and breakdown.
Choice D rationale
Giving the child a dose of acetaminophen as prescribed for pain is important for pain management, but it is not the most important home care information. While essential for comfort, it does not address the critical neurovascular assessment needed to prevent severe complications like compartment syndrome.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Promoting range-of-motion is typically achieved through exercises and movement. Dynamic splinting aims to maintain a specific joint position rather than actively increasing range of motion, which might be counterproductive to hip stability in developmental dysplasia.
Choice B rationale
Increasing extension would involve straightening the hip joint. In developmental dysplasia of the hip, the goal of treatment is to maintain the femoral head within the acetabulum, which often requires a flexed and abducted position, not extension.
Choice C rationale
Maintaining abduction is the primary purpose of dynamic splinting in developmental dysplasia of the hip. Abduction helps to seat the femoral head deeply into the acetabulum, promoting proper hip development and stability by stimulating acetabular ossification.
Choice D rationale
Providing immobilization implies completely restricting movement. Dynamic splinting, like the Pavlik harness, allows some movement while maintaining the abduction, flexion, and external rotation necessary for proper hip development. Full immobilization is typically not the goal for developmental dysplasia.
Correct Answer is D
Explanation
Choice A rationale
This schedule is incorrect for pertussis (whooping cough) immunization. Pertussis vaccination, usually as part of the DTaP vaccine, is initiated in infancy and requires multiple doses to build adequate immunity, not just a single dose at 1 year or 6 years of age.
Choice B rationale
This schedule is incorrect and deviates from the standard recommendations for pertussis vaccination. The typical primary series of DTaP vaccination begins earlier in infancy and includes specific booster doses at later ages to maintain protection against the disease.
Choice C rationale
This schedule is incorrect for pertussis immunization. While some vaccinations begin at birth, and boosters are given periodically, the specific timing and frequency for pertussis in this option do not align with the established guidelines for the DTaP or Tdap vaccines.
Choice D rationale
This is the recommended immunization schedule for pertussis, typically administered as part of the DTaP vaccine. The primary series at 2, 4, and 6 months establishes foundational immunity, and boosters at 15-18 months and 4-6 years of age are crucial for maintaining long-term protection against the disease.
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