A client with an external fixation device for a fractured left femur is troubled with left foot pain. Which intervention should the nurse implement first?

Choice A reason: A cerebrovascular accident (CVA), commonly known as a stroke, occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Although a severe headache might be a symptom of a stroke, it does not typically present with fever, nuchal rigidity, and a petechial rash, which are more indicative of an infection or inflammatory process.

Choice B reason: Meningococcal meningitis is a bacterial infection that causes inflammation of the membranes covering the brain and spinal cord. Symptoms often include a severe headache, fever, neck stiffness (nuchal rigidity), and a petechial rash, which is a distinguishing feature. This condition is a medical emergency and requires prompt antibiotic treatment to prevent serious complications or death.

Choice C reason: Intracerebral hemorrhage is bleeding within the brain tissue itself, which can be caused by various factors such as hypertension, aneurysms, or trauma. While it can cause a severe headache and neurological symptoms, it does not typically present with fever, nuchal rigidity, and a petechial rash, which suggest an infectious etiology rather than a hemorrhagic one.

Choice D reason: Rocky Mountain spotted fever is a tick-borne illness caused by the bacterium Rickettsia rickettsii. It can present with fever, headache, and a rash, but the rash is typically more generalized and not petechial. Additionally, the presence of nuchal rigidity and severe headache are more characteristic of meningitis rather than Rocky Mountain spotted fever.

Choice A reason: Central line insertion is not the appropriate intervention for managing stridor in a postoperative parathyroidectomy patient. Stridor indicates airway obstruction, which requires immediate airway management, not central venous access. Inserting a central line would not address the underlying issue of compromised airway patency, and it would delay necessary interventions to secure the airway.

Choice B reason: Nasogastric tube (NGT) insertion is not the correct intervention for stridor. NGT insertion is typically used for gastrointestinal decompression or feeding, not for managing airway obstruction. In the context of a client experiencing stridor, the priority is to ensure a patent airway, not to manage gastrointestinal issues. NGT insertion could potentially exacerbate airway compromise in a client with stridor.

Choice C reason: Tracheostomy placement is the correct intervention for managing stridor in a postoperative parathyroidectomy patient. Stridor indicates a potential airway obstruction, which can be life-threatening. A tracheostomy provides a secure airway and ensures adequate ventilation. This procedure is particularly important in cases where upper airway obstruction is suspected, such as swelling or hematoma formation following neck surgery.

Choice D reason: Pacemaker placement is not relevant to managing stridor. Pacemakers are used for cardiac rhythm management and do not address airway obstruction. The immediate concern for a client with stridor is ensuring a patent airway, and pacemaker placement would not resolve the airway compromise.