A patient who fell in the bathroom of the hospital room reports pain in the upper right arm and elbow. Which action would the nurse take first in managing a possible fracture before splinting the injury?

Apply ice to the site.

Elevate the arm

Notify the health care provider

Perform a neurovascular check below the injury

Answer and Explanation

The Correct Answer is D

Choice A reason: Applying ice reduces swelling and pain in a possible fracture, which is beneficial but not the first priority. Ice application does not assess the limb’s viability or detect complications like vascular injury or nerve damage. A neurovascular check is critical to ensure circulation and nerve function before interventions like ice, which could mask symptoms.

Choice B reason: Elevating the arm minimizes swelling by promoting venous return, aiding in pain relief and reducing pressure. However, it is secondary to a neurovascular check, which assesses circulation, sensation, and movement. Elevation without confirming vascular integrity risks missing critical injuries like arterial compression, which could lead to ischemia if untreated.

Choice C reason: Notifying the health care provider is necessary for diagnostic imaging and treatment planning but is not the first action. A neurovascular check provides immediate data on limb status, guiding urgency of notification. Delaying assessment risks missing acute complications like compartment syndrome, which requires prompt intervention to prevent permanent damage.

Choice D reason: Performing a neurovascular check first assesses distal pulses, sensation, movement, and capillary refill, detecting complications like vascular occlusion or nerve injury from a possible fracture. Fractures can compress arteries or nerves, risking ischemia or neuropathy. Early identification ensures timely intervention, making this the priority before splinting or other actions to preserve limb function.

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Correct Answer is A

Explanation

Choice A reason: Morning stiffness lasting 60 minutes or more is a hallmark of rheumatoid arthritis (RA) due to synovial inflammation in affected joints. This prolonged stiffness, worse after inactivity, reflects autoimmune-mediated synovitis, distinguishing RA from osteoarthritis. Recognizing this guides diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs) to reduce joint damage.

Choice B reason: Bamboo-shaped fingers are characteristic of psoriatic arthritis, not RA. RA causes joint deformities like swan-neck or boutonnière due to synovial destruction, not a bamboo appearance. Expecting this finding risks misdiagnosis, delaying RA-specific therapies like methotrexate, which target inflammation and prevent progressive joint erosion.

Choice C reason: Asymmetric small joint involvement is typical of osteoarthritis or psoriatic arthritis, not RA. RA features symmetric involvement of small joints, like metacarpophalangeal joints, due to systemic autoimmune inflammation. Assuming asymmetry misguides assessment, potentially overlooking RA’s bilateral pattern critical for early diagnosis and effective immunosuppressive treatment.

Choice D reason: Noninflammatory pain in large joints is not typical of RA, which involves inflammatory pain in small joints due to synovitis. Large joint pain may occur in osteoarthritis or gout. Expecting noninflammatory pain misdirects RA diagnosis, delaying interventions like corticosteroids or biologics to manage inflammation and joint destruction.

A. There is no need to cover the cast when showering. B. Apply ice to your foot after walking. C. A musty odor is normal as the cast ages. D. Report any numbness or pain in your toes.

Correct Answer is D

Explanation

Choice A reason: Plaster of Paris casts must be kept dry, as water weakens the material, causing breakdown or skin maceration. Covering the cast with a waterproof barrier during showering is essential. This instruction is incorrect, as it risks cast damage and skin infections, which could complicate recovery.

Choice B reason: Applying ice after walking may reduce swelling, but it is not a standard instruction for a walking cast unless edema is present. Ice can dampen the cast, risking structural integrity. Monitoring neurovascular status is more critical, making this less essential compared to reporting symptoms.

Choice C reason: A musty odor is not normal and may indicate moisture, skin breakdown, or infection beneath the cast. Patients should report odors, as they suggest complications requiring evaluation. This instruction is incorrect, as it dismisses a potential sign of serious issues like bacterial growth or tissue damage.

Choice D reason: Reporting numbness or pain in the toes is critical, as these symptoms may indicate neurovascular compromise, such as compartment syndrome or nerve compression from a tight cast. Early reporting ensures timely intervention to prevent permanent damage, making this a key instruction for safe cast management and recovery.

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A patient who fell in the bathroom of the hospital room reports pain in the upper right arm and elbow. Which action would the nurse take first in managing a possible fracture before splinting the injury?

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Correct Answer is A

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Correct Answer is D

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