A client with type 1 diabetes is receiving insulin therapy. The nurse observes the patient experiencing symptoms such as sweating, trembling, and confusion. What is the nurse’s first action?

Choice A reason: Ecchymosis, or bruising, may occur with a fracture due to soft tissue injury and bleeding but is not specific to fractures. It results from ruptured blood vessels in the skin, not bone disruption, and can occur in many trauma scenarios, making it less definitive than crepitus for fracture assessment.

Choice B reason: Crepitus, the grating sound or sensation from bone fragments rubbing together, is a hallmark of fractures. It occurs due to disrupted bone continuity, detectable during physical examination. This clinical manifestation is highly specific to fractures, making it the most accurate choice for a nurse’s assessment focus.

Choice C reason: Shock can occur with severe fractures due to blood loss or pain but is not a direct manifestation of the fracture itself. It reflects systemic response to trauma, not the localized bone injury, making it less specific than crepitus for identifying a fracture during assessment.

Choice D reason: Deformity is a common fracture sign due to bone misalignment but is not always present, especially in hairline or non-displaced fractures. Crepitus is more consistently detectable in physical exams, as it directly results from bone fragment movement, making it a more reliable clinical manifestation.

Choice A reason: PPIs are used for short-term treatment of ulcers and gastroesophageal reflux disease (GERD), typically 4-8 weeks, not long-term, due to risks like nutrient deficiencies or infections. Long-term use is reserved for specific conditions like Barrett’s esophagus, making this statement inaccurate for general use.

Choice B reason: While PPIs are available orally and intravenously, this is not the primary focus of patient education. Their efficacy in suppressing acid production is more critical than administration routes. This statement is less relevant, as it does not address therapeutic use or safety considerations.

Choice C reason: PPIs cause adverse effects in older adults, including increased risks of fractures, Clostridium difficile infection, and vitamin B12 deficiency due to prolonged acid suppression. This statement is inaccurate, as older clients are particularly susceptible to these risks, requiring careful monitoring during PPI therapy.

Choice D reason: PPI treatment emphasizes the lowest effective dose for the shortest duration to minimize risks like infections, fractures, or nutrient malabsorption. This approach balances acid suppression with safety, especially for ulcers or GERD, making this statement accurate and critical for patient education on safe use.