A client who has developed acute compartment syndrome from a compound fracture of the arm asks the nurse to define what this means. Based on an understanding of the condition, the nurse should explain that:

Bleeding and swelling cause increased pressure under the fascia.

Displaced bones compress nerves and vessels.

Blood supply to the bone is interrupted.

Compression of the muscle tissue restricts blood flow to the area.

Answer and Explanation

The Correct Answer is A

Choice A Reason
Acute compartment syndrome occurs when bleeding or swelling within an enclosed bundle of muscles – known as a muscle compartment – leads to increased pressure. This pressure can impede blood flow to the body tissue and destroy function. The fascia, which is a tough layer of fibrous tissue, does not stretch easily, so any swelling or bleeding can quickly lead to increased pressure.

Choice B Reason
While displaced bones can compress nerves and vessels, this is not the primary mechanism of acute compartment syndrome. Displaced bones are more likely to cause direct injury or impingement, but compartment syndrome specifically refers to the pressure build-up within a muscle compartment that affects circulation and tissue viability.

Choice C Reason
Interruption of blood supply to the bone is a serious concern and can lead to conditions such as avascular necrosis. However, in the context of acute compartment syndrome, the primary issue is the pressure within the muscle compartment rather than direct disruption of blood supply to the bone.

Choice D Reason
Compression of muscle tissue can restrict blood flow to the area, which is a part of the pathophysiology of compartment syndrome. However, the compression is a result of increased pressure within the compartment, not the primary cause. The increased pressure is due to bleeding and swelling, which is why choice A is the most accurate description.

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Correct Answer is A

Explanation

Choice a reason:
Increasing fiber intake is crucial for clients with diverticular disease. A high-fiber diet softens the stool and helps it pass more easily, reducing the pressure in the digestive tract. Fresh fruits and vegetables are excellent sources of fiber and other nutrients essential for maintaining a healthy digestive system. The Dietary Guidelines for Americans recommend a dietary fiber intake of 14 grams per 1,000 calories consumed, which equates to 28 grams per day for a 2,000-calorie diet.

Choice b reason:
While avoiding foods high in sugar is generally good advice for overall health, it is not specifically related to the management of diverticular disease. There is no direct link between sugar intake and the symptoms or complications of diverticular disease. However, a diet high in sugar can contribute to obesity, which is a risk factor for the development of diverticulosis.

Choice c reason:
Decreasing fluid intake is not recommended for clients with diverticular disease. In fact, adequate hydration is essential when increasing fiber intake. Fluids help fiber work better by allowing it to absorb water and expand, aiding in easier passage through the intestines.

Choice d reason:
The previous belief that small seeds and nuts should be avoided by individuals with diverticular disease has been debunked. Recent studies have shown that these foods do not increase the risk of complications and are not harmful to individuals with this condition. Therefore, this advice is outdated and no longer considered necessary as part of dietary teaching for diverticular disease.

A. Cyanosis noted in nail beds bilaterally. B. Lungs clear to auscultation. C. Inability to speak in full sentences. D. Pulse oximetry 94-96% on room air.

Correct Answer is ["B","D"]

Explanation

Choice A reason:
Cyanosis, or a bluish discoloration of the skin, particularly in the nail beds, is a sign of inadequate oxygenation and would not indicate successful intervention. The absence of cyanosis would be a positive outcome, reflecting improved oxygen saturation.

Choice B reason:
Lungs clear to auscultation would indicate that air is moving through all regions of the lungs without obstruction from fluid or mucus, which is a sign of recovery from pneumonia. This finding suggests that the interventions aimed at improving gas exchange, such as positioning, deep breathing exercises, and suctioning if needed, have been effective.

Choice C reason: The inability to speak in full sentences often indicates respiratory distress and would not be a sign of successful nursing intervention. An improvement would be the client's ability to speak in full sentences without difficulty, reflecting better lung function and gas exchange.

Choice D reason:
Pulse oximetry readings between 94-96% on room air are within normal limits and indicate adequate oxygen saturation and gas exchange. This is a clear sign that the client's respiratory status has improved, and the interventions for Impaired Gas Exchange have been successful.

Choice E reason:
Bronchovesicular breath sounds are normal breath sounds heard over the major bronchi and are typically moderate in pitch and intensity. However, they are not specifically indicative of successful intervention for Impaired Gas Exchange. The absence of abnormal sounds such as crackles or wheezes would be more relevant.

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A client who has developed acute compartment syndrome from a compound fracture of the arm asks the nurse to define what this means. Based on an understanding of the condition, the nurse should explain that:

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has just been diagnosed with diverticular disease. What dietary teaching will the nurse provide?

Correct Answer is A

Explanation

A nurse implements a plan of care for a client with the problem of Impaired Gas Exchange as a result of left lower lobe pneumonia. Which findings would indicate that nursing interventions were successful? (Select all that apply)

Correct Answer is ["B","D"]

Explanation

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