A client with psoriasis reports an increase in symptoms. Which action should the practical nurse (PN) implement?

Choice A reason: Fat emboli, or fat embolism syndrome (FES), is the most critical complication to monitor for in a client who had a long bone fracture repaired. This condition occurs when fat droplets from the bone marrow enter the bloodstream and travel to the lungs, brain, or other organs. Symptoms can include respiratory distress, confusion, and a petechial rash. FES can develop within 24 to 72 hours after the injury or surgery and can be life-threatening. Therefore, it is essential to observe for signs such as sudden shortness of breath, rapid breathing, changes in mental status, and the characteristic rash. Early detection and intervention are crucial to manage this potentially severe complication.
Choice B reason: Urinary retention is a possible postoperative complication due to anesthesia or immobility. It is important to monitor urine output and ensure that the client is voiding adequately. However, it is not as immediately life-threatening as a fat embolism. While urinary retention requires attention and management, the practical nurse should prioritize monitoring for signs of fat embolism due to its more severe and acute nature.
Choice C reason: Nonunion refers to the failure of the fracture to heal properly, which can lead to chronic pain and functional impairment. This complication typically develops over a more extended period rather than immediately postoperatively. Monitoring for signs of nonunion, such as persistent pain and lack of healing on follow-up X-rays, is important. However, it is not the most urgent concern in the immediate postoperative period when compared to the risk of a fat embolism.
Choice D reason: Muscular spasms can occur after a fracture as the muscles around the injury site contract to protect and stabilize the affected area. These spasms can be painful and impact the client's comfort and mobility. While it is necessary to address muscle spasms through pain management and physical therapy, they are generally not life-threatening. The practical nurse should focus on monitoring for signs of fat embolism, which poses a more immediate risk to the client's health.

Choice A reason: Commending the client for ensuring an adequate source of vitamin C in the diet is not the best response. While vitamin C is important for overall health, it does not directly impact bone density. The client's focus on orange juice may stem from a misunderstanding of the nutrients that are critical for bone health, such as calcium and vitamin D. A better approach would be to address the specific nutrients that support bone density and clarify any misconceptions.
Choice B reason: Advising the client of the need to remain NPO (nothing by mouth) until the test is completed is not necessary for a bone density test. Bone density tests, such as dual-energy X-ray absorptiometry (DEXA) scans, do not require the client to fast beforehand. Providing this advice would be incorrect and could cause unnecessary concern or confusion for the client.
Choice C reason: Determining if the client drinks orange juice that has been fortified with calcium is a helpful step, but it does not address the immediate need to correct the client's misunderstanding about the purpose of the bone density test. While calcium-fortified orange juice can be beneficial for bone health, the priority should be to ensure the client has accurate information about the test they are undergoing.
Choice D reason: Correcting the client's misunderstanding of the purpose of bone density testing is the most appropriate response. The primary goal of a bone density test is to measure the density of the bones and assess the risk of fractures, not to diagnose or confirm the presence of osteoporosis. By providing clear and accurate information about the test, the practical nurse can help the client understand its purpose and alleviate any misconceptions. This response also opens the door for further education on managing osteoporosis and ensuring the client is receiving the necessary nutrients for bone health.