A nurse is caring for a client who has a femur fracture. The nurse suspects that the client has fat embolism syndrome. Which of the following findings should the nurse identify as an early manifestation of fat embolism syndrome?

Hypoxemia

Headache

Petechiae

Precordial chest pain

Answer and Explanation

The Correct Answer is A

A. Hypoxemia is an early sign of fat embolism syndrome due to the presence of fat globules in the pulmonary circulation.

B. Headache can be associated with hypoxemia but is not as specific or immediate as hypoxemia itself.

C. Petechiae, while a classic sign, usually appear later in the progression of fat embolism syndrome.

D. Precordial chest pain may occur but is not typically the first sign; hypoxemia is usually noted first.

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

Explanation

A. A turning schedule every 4 hours is insufficient; repositioning should ideally be done every 2 hours to prevent pressure injuries.

B. Reducing skin exposure to moisture helps maintain skin integrity, especially in areas prone to breakdown due to moisture accumulation.

C. Powder is not recommended as it can lead to skin irritation and potential breakdown.

D. Elevating heels with pillows relieves pressure on areas that are susceptible to pressure injuries in immobilized clients.

E. Massaging erythematous bony prominences can damage capillaries and increase the risk of pressure injury formation.

A. Raise the foot of the bed to a 90° angle. B. Prepare to insert a central line. C. Remove the dressing to inspect the wound. D. Administer oxygen via nasal cannula.

Correct Answer is D

Explanation

A. Raising the foot of the bed to a 90° angle is not an appropriate intervention for a chest wound as it may impair respiratory function further.

B. Preparing to insert a central line is not a priority action in managing a sucking chest wound and may delay more immediate life-saving interventions.

C. Removing the dressing to inspect the wound can worsen the condition by allowing more air to enter, increasing the risk of a tension pneumothorax.

D. Administering oxygen via nasal cannula provides essential oxygen support, addressing hypoxia caused by the impaired respiratory function from the chest wound.

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A nurse is caring for a client who has a femur fracture. The nurse suspects that the client has fat embolism syndrome. Which of the following findings should the nurse identify as an early manifestation of fat embolism syndrome?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is developing a plan of care to prevent skin breakdown for a client with a spinal cord injury and paralysis. Which of the following nursing actions are appropriate?

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

Explanation

A nurse in an emergency department is caring for a client who has a sucking chest wound resulting from a gunshot. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a respiratory rate of 40/min. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

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