A nurse is planning care for a school-age child following the application of a plaster cast for a right forearm fracture. Which of the following interventions should the nurse plan to implement?
Apply plastic covering to the cast until dry.
Apply pieces of moleskin around the edges of the cast.
Use tips of fingers to reposition the cast until dry.
Maintain casted extremity below heart level.
The Correct Answer is B
A. Apply plastic covering to the cast until dry. Covering the cast with plastic can cause moisture accumulation, which can delay drying and increase the risk of infection and skin irritation. The cast should be allowed to dry naturally and in a well-ventilated area.
B. Apply pieces of moleskin around the edges of the cast. Applying moleskin around the edges of the cast helps to protect the skin from irritation and potential injury from the rough edges of the cast. This is an appropriate intervention.
C. Use tips of fingers to reposition the cast until dry. Using the tips of fingers to handle the cast while it is drying can create indentations, leading to pressure points and potential skin breakdown. The cast should be handled with the palms of the hands to avoid indentations.
D. Maintain casted extremity below heart level. The casted extremity should be elevated above heart level, especially in the first 24-48 hours, to reduce swelling and promote venous return. Keeping it below heart level can increase swelling.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Auscultate the abdomen for at least 1 min if bowel sounds are absent. This is an appropriate action. Absence of bowel sounds can indicate a serious condition, so the nurse should auscultate for at least 1 minute to confirm their absence. However, it is generally recommended to listen for up to 5 minutes before concluding that bowel sounds are absent.
B. Use the bell stethoscope to auscultate breath sounds. The diaphragm of the stethoscope, not the bell, is typically used to auscultate breath sounds because it is better at picking up higher-pitched sounds like those of the lungs.
C. Check visual acuity by using the tumbling E eyechart. The tumbling E chart is appropriate for pre-schoolers who may not know the alphabet. This chart helps assess visual acuity in young children by having them identify the direction of the E's legs.
D. Place hand on the pre-schooler’s abdomen to determine respiratory rate. Placing a hand on the abdomen can help in counting the respiratory rate in infants and very young children who are diaphragmatic breathers, but for pre-schoolers, it is typically easier and more accurate to count respirations by observing the chest rise.
Correct Answer is D
Explanation
A. Decreased heart rate: Dehydration typically causes an increased heart rate (tachycardia) rather than a decreased heart rate.
B. Bulging fontanelle: A bulging fontanel can indicate increased intracranial pressure or overhydration. Dehydration, which is more common with diarrhea, would more likely cause a sunken fontanel.
C. Polyuria: Polyuria (increased urine output) is not expected with dehydration. Dehydration often results in oliguria (decreased urine output).
D. Increased haematocrit: Correct. Dehydration can cause hemoconcentration, which leads to an increased haematocrit as the blood becomes more concentrated.
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