A nurse is caring for a client who has a new short-leg cast on his lower leg to treat an ankle fracture. Which of the following findings requires immediate notification of the provider?
Ecchymosis of the distal foot
Dependent edema distal to the cast
Moderate level of pain
Inability to flex the toes of the casted foot
The Correct Answer is D
A. Ecchymosis of the distal foot may be expected after the application of a cast and is not necessarily an immediate concern unless it is severe or rapidly worsening.
B. Dependent edema distal to the cast can occur as a normal response to immobilization. It is not an immediate concern unless it is severe or associated with other concerning symptoms.
C. A moderate level of pain can be expected after the application of a cast. It should be managed appropriately, but it is not an immediate concern unless it is severe or uncontrolled.
D. Inability to flex the toes of the casted foot suggests a potential issue with circulation or nerve function, which requires immediate notification of the provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Palpating the femoral pulse is an essential part of assessing the neurovascular status of a client with a femur fracture. The presence and strength of the femoral pulse can indicate adequate blood flow to the lower extremity.
B. While measuring the circumference of the thigh can provide some information about swelling or changes in the size of the limb, it does not directly assess neurovascular status.
C. Monitoring the client's calf for edema is important for assessing for signs of deep vein thrombosis (DVT) or venous insufficiency, but it is not the primary technique for assessing neurovascular status.
D. Instructing the client to wiggle his toes is a way to assess motor function and nerve function, which is part of the neurovascular assessment. However, it is not the initial step in assessing neurovascular status in a client with an unrepaired femur fracture. The femoral pulse should be assessed first to ensure adequate blood flow.
Correct Answer is C
Explanation
A. Fasting is not necessary for a dual-energy x-ray absorptiometry (DXA) scan, as it does not involve ingesting anything.
B. The client does not need to lie flat for an extended period following a DXA scan. They can resume normal activities immediately after the test.
C.The nurse should instruct the client to remove all jewelry or metal objects that can interfere with the test. A DXA scan is the mostly commonly used screening and diagnostic tool for measuring bone mineral density.
D. . It is not necessary to empty the bladder before the test.
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