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A nurse performing a head to toe neurovascular check on a patient in a long leg cast notes an indication of altered perfusion as evidenced by:

warm feet and hands.

numbness of distal limb.

palpable peripheral pulses.

capillary refill of 3 seconds.

Answer and Explanation

The Correct Answer is B

A. Warm feet and hands.

Warmth suggests good blood flow and is a normal finding.

B. Numbness of distal limb.

Numbness is a sign of neurovascular compromise, possibly from swelling or impaired circulation due to the cast.

C. Palpable peripheral pulses.

Pulses are a positive finding indicating adequate perfusion.

D. Capillary refill of 3 seconds.

Capillary refill less than or equal to 3 seconds is considered normal.

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Correct Answer is B

Explanation

A. Speeding the drying with a hair dryer:

This is not recommended as it can cause uneven drying and burns. Plaster casts must dry naturally.

B. Elevating the leg on one to two pillows:

Elevation promotes venous return and reduces swelling in the affected extremity.

C. Petaling the edges of the cast:

Petaling helps prevent skin breakdown from rough cast edges but does not affect edema.

D. Placing the patient in high Fowler's position:

This position benefits respiratory function but does not aid in reducing lower extremity edema.

A. Hold the crutches on your unaffected side when preparing to sit in a chair B. Hold the crutches 9 inches in front and to the side of each foot C. Lean on the crutches to support your body weight when standing D. Fully extend your arms when holding onto the hand grips

Correct Answer is A

Explanation

A. Hold the crutches on your unaffected side when preparing to sit in a chair

This helps maintain balance and control while transitioning from standing to sitting.

B. Hold the crutches 9 inches in front and to the side of each foot

The correct placement is approximately 6 inches (not 9) in front and 6 inches to the side of each foot for stability.

C. Lean on the crutches to support your body weight when standing

Weight should be supported by the hands on the handgrips, not the axillae, to avoid nerve injury (e.g., brachial plexus damage).

D. Fully extend your arms when holding onto the hand grips

The elbows should be slightly flexed (about 20-30 degrees) to allow proper support and shock absorption.

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A nurse performing a head to toe neurovascular check on a patient in a long leg cast notes an indication of altered perfusion as evidenced by:

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Naxlex Comprehensive Predictor Exams

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