A nurse is caring for a client who just had a left long-arm plaster cast applied after experiencing a musculoskeletal trauma. Which of the following actions should the nurse take?
Position the cast on a plastic-covered pillow.
Perform neurovascular checks every 2 hr.
Instruct the client to avoid moving the fingers on the left hand.
Touch the cast with the palms of the hands when moving the client.
The Correct Answer is B
A) Position the cast on a plastic-covered pillow:
Positioning the cast on a plastic-covered pillow is not recommended because the plastic can trap moisture and heat, potentially affecting the cast's integrity as it dries. Instead, a soft, absorbent material should be used to support the cast.
B) Perform neurovascular checks every 2 hr:
Frequent neurovascular checks are essential to monitor for complications such as compartment syndrome, nerve damage, or impaired circulation. This action helps ensure that any changes in sensation, movement, or circulation are identified and addressed promptly.
C) Instruct the client to avoid moving the fingers on the left hand:
Encouraging the client to move their fingers is important to prevent stiffness and swelling and to promote circulation. Instructing the client to avoid moving their fingers is not appropriate and could lead to complications.
D) Touch the cast with the palms of the hands when moving the client:
Handling a wet plaster cast with the palms of the hands is correct to prevent indentations and pressure points that could cause skin irritation or pressure sores. However, this action is not as critical as performing frequent neurovascular checks to ensure the client's safety and monitor for complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","E"]
Explanation
A) Tachypnea:
Tachypnea, or rapid breathing, is not a typical symptom of acute pyelonephritis. This condition primarily affects the kidneys and urinary tract, and while it can cause systemic symptoms, tachypnea is more commonly associated with respiratory issues.
B) Nausea:
Nausea is a common symptom of acute pyelonephritis. The infection and inflammation of the kidneys can lead to gastrointestinal symptoms, including nausea and vomiting.
C) Hypothermia:
Hypothermia, or abnormally low body temperature, is not commonly associated with acute pyelonephritis. Patients with this condition are more likely to present with fever rather than hypothermia.
D) Bradycardia:
Bradycardia, or slow heart rate, is not typically seen in acute pyelonephritis. In fact, systemic infections and the associated fever can often lead to an increased heart rate (tachycardia).
E) Flank pain:
Flank pain is a hallmark symptom of acute pyelonephritis. The pain is usually located in the back and sides, near the affected kidney, and can be quite severe. This pain results from the inflammation and infection of the kidney.
Correct Answer is ["A","C","E"]
Explanation
A) Headache:
Headache is a common adverse effect of albuterol due to its action on the central nervous system. The medication can cause vasodilation and changes in blood flow, leading to headaches. Parents should be aware of this potential side effect and manage it accordingly.
B) Hypotension:
Hypotension is not a typical adverse effect of albuterol. Albuterol primarily acts as a beta-2 agonist, leading to bronchodilation and some cardiovascular effects, but it generally does not cause a drop in blood pressure. Instead, it may occasionally increase blood pressure in some individuals.
C) Hyperactivity:
Hyperactivity is a known side effect of albuterol, especially in children. This occurs due to the stimulant effects of the medication on the central nervous system, leading to increased restlessness and activity levels. Parents should monitor their child's behavior for signs of increased hyperactivity.
D) Decreased pulse rate:
Decreased pulse rate (bradycardia) is not associated with albuterol use. Albuterol tends to cause tachycardia, an increased heart rate, due to its beta-adrenergic stimulating effects. Monitoring the pulse rate is essential, but a decreased rate is not a typical concern with this medication.
E) Tremors:
Tremors are a common adverse effect of albuterol, resulting from the stimulation of beta-adrenergic receptors in the muscles. This can cause muscle shaking or jitteriness, particularly in the hands. Parents should be informed about this possible side effect and observe their child for signs of tremors.
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