A large tree fell across the thighs of a man who works as a logger, producing a crushing injury. The muddy ground cushioned the impact and x-rays revealed no broken bones. His thighs are bruised and swollen with pedal pulses present, but the left is stronger than the right. It is most important for the nurse to include in this client's plan of care assessment for signs of which pathophysiological condition?

Peripheral neuropathy.

Osteomyelitis.

Fat embolism.

Compartment syndrome.

Answer and Explanation

The Correct Answer is D

A) Peripheral neuropathy:

Peripheral neuropathy involves damage to the peripheral nerves and is not directly related to the described crushing injury. While nerve injury can occur as a result of trauma, the signs and symptoms described in the scenario, such as unequal strength between the left and right thighs, are more indicative of a potential vascular or musculoskeletal issue rather than peripheral neuropathy.

B) Osteomyelitis:

Osteomyelitis is a bone infection that can occur secondary to trauma or as a complication of open fractures. While it is possible for a crushing injury to lead to osteomyelitis if there is bone involvement or an open wound, the scenario mentions that x-rays revealed no broken bones. Additionally, the signs and symptoms described, such as bruising and swelling of the thighs, are not specific to osteomyelitis.

C) Fat embolism:

Fat embolism occurs when fat globules enter the bloodstream, often following traumatic injury to long bones or orthopedic procedures. While a crushing injury can theoretically lead to fat embolism, the absence of long bone fractures in the x-rays makes this less likely. Additionally, fat embolism typically presents with respiratory symptoms such as dyspnea and hypoxemia, which are not described in the scenario.

D) Compartment syndrome:

Correct. Compartment syndrome is a serious condition that can occur following a crushing injury, especially in the extremities. It is characterized by increased pressure within a muscle compartment, leading to compromised blood flow and potential tissue damage. Signs and symptoms of compartment syndrome include severe pain, swelling, bruising, decreased or absent pulses, and neurological deficits. The unequal strength between the left and right thighs could indicate neurological deficits due to compromised blood flow or nerve compression, making assessment for signs of compartment syndrome crucial in this client's plan of care. If compartment syndrome is suspected, prompt medical intervention, such as fasciotomy to relieve pressure, may be necessary to prevent complications.

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Correct Answer is D

Explanation

A) Shivering:

Shivering is not a normal inflammatory response to wound healing. It may indicate systemic symptoms such as fever or chills, which could be indicative of infection or other complications.

B) Purulent drainage:

Purulent drainage (pus) is often a sign of infection rather than a normal inflammatory response to wound healing. While some serous or serosanguinous drainage may be expected initially, purulent drainage suggests an abnormal response.

C) Temperature of 102° F (37.8° C):

A temperature of 102° F (37.8° C) is indicative of fever, which can occur in response to infection or inflammation. While fever is part of the inflammatory response, it is not necessarily considered a normal finding in the context of wound healing and may indicate an abnormal response such as infection.

D) Redness and localized heat:

Correct. Redness (erythema) and localized heat are typical signs of the inflammatory phase of wound healing. Inflammation is a normal response to tissue injury and is characterized by increased blood flow to the area, resulting in redness and warmth. These signs indicate that the body's immune response is active and working to repair the injured tissue.

A. Flank pain and profound hypotension. B. Acute shortness of breath and chest pain. C. Absent pedal pulses and darkened toes. D. Tea-colored urine and decreased output.

Correct Answer is A

Explanation

A) Flank pain and profound hypotension:

Correct. Flank pain, often described as a deep, constant, gnawing, or throbbing sensation in the abdomen or back, can be a sign of impending rupture or dissection of an abdominal aortic aneurysm (AAA). Profound hypotension may occur if the AAA ruptures, leading to massive internal bleeding and shock. Prompt recognition of these signs is crucial for early intervention and surgical repair to prevent catastrophic consequences.

B) Acute shortness of breath and chest pain:

Acute shortness of breath and chest pain are more indicative of cardiovascular or pulmonary conditions such as myocardial infarction, pulmonary embolism, or acute coronary syndrome rather than an abdominal aortic aneurysm. While aortic dissection can present with chest pain, it is typically described as severe, tearing, or ripping pain that radiates to the back, not as acute shortness of breath.

C) Absent pedal pulses and darkened toes:

Absent pedal pulses and darkened toes may indicate peripheral vascular disease or critical limb ischemia but are not specific signs of an abdominal aortic aneurysm. While AAA can lead to peripheral ischemia in advanced cases, it is not typically associated with acute changes in pedal pulses or toe discoloration.

D) Tea-colored urine and decreased output:

Tea-colored urine and decreased urine output may indicate acute kidney injury or rhabdomyolysis but are not specific signs of an abdominal aortic aneurysm. While a ruptured AAA can lead to renal ischemia and acute kidney injury due to hypoperfusion, these symptoms are not the primary manifestations of AAA

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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