An 18-year-old male patient arrives at the emergency department.
He has a cast to his lower leg.
He explains that he is in severe pain unrelieved by analgesics, paresthesia in his toes, and the nurse notes decreased capillary refill.
What is the most appropriate initial nursing intervention for this patient?
Perform a fasciotomy to relieve the pressure in the compartment.
Loosen the cast dressings or bandages on the affected limb.
Elevate the affected limb above heart level to decrease swelling.
Apply ice to the affected area to reduce swelling.
The Correct Answer is B
Choice A rationale
Performing a fasciotomy is a surgical procedure, not an initial nursing intervention. While it may be necessary to relieve compartment syndrome, it is outside the scope of nursing practice and is typically performed by a physician. The nurse's role is to identify the signs and symptoms and escalate to the medical team for this definitive treatment.
Choice B rationale
Loosening the cast dressings or bandages directly addresses the potential cause of compartment syndrome by reducing external compression. This action aims to improve blood flow and nerve function by alleviating pressure on the neurovascular structures within the confined space. This can prevent further tissue ischemia and damage.
Choice C rationale
Elevating the affected limb above heart level can paradoxically worsen compartment syndrome. Elevation decreases arterial perfusion pressure, further compromising blood flow to the already ischemic tissues within the rigid fascial compartment. This can exacerbate tissue hypoxia and cellular damage, increasing the risk of irreversible injury.
Choice D rationale
Applying ice to the affected area causes vasoconstriction, which would further reduce blood flow to the compromised tissues within the compartment. This decrease in perfusion would exacerbate ischemia and hypoxia, potentially worsening tissue damage and accelerating the progression of compartment syndrome. Therefore, ice application is contraindicated.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Legg-Calvé-Perthes disease involves avascular necrosis of the femoral head, requiring strict adherence to prescribed treatment, such as bracing or limited weight-bearing, to promote revascularization and prevent femoral head deformity. Non-compliance significantly increases the risk of long-term osteoarthritis and functional limitations.
Choice B rationale
Legg-Calvé-Perthes disease is not a terminal illness. While it can lead to chronic hip problems if not properly managed, it is a self-limiting condition where the bone eventually regenerates, albeit sometimes with residual deformity.
Choice C rationale
While pain management may be necessary, antibiotics are not a primary treatment for Legg-Calvé-Perthes disease as it is an aseptic necrosis, not an infection. The focus is on preserving the femoral head and restoring its blood supply.
Choice D rationale
Rehabilitation to regain mobility might be part of the long-term management after the acute phase or surgery, but the initial and key focus is on preventing further damage to the femoral head and ensuring proper healing, which often involves activity restriction.
Correct Answer is A
Explanation
Choice A rationale
NSAIDs (Nonsteroidal Anti-inflammatory Drugs) are commonly the first-line treatment for juvenile idiopathic arthritis (JIA). They work by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), thereby reducing the production of prostaglandins, which are inflammatory mediators responsible for pain, swelling, and stiffness in the joints.
Choice B rationale
Antifungal medications are used to treat fungal infections. JIA is an autoimmune inflammatory condition, not caused by fungal pathogens. Therefore, antifungal medications have no therapeutic role in the management of juvenile idiopathic arthritis.
Choice C rationale
Antibiotics are specifically designed to combat bacterial infections. JIA is an autoimmune disease where the body's immune system mistakenly attacks its own tissues, primarily joints. It is not caused by bacteria, so antibiotics are ineffective for its treatment.
Choice D rationale
Antiviral medications are used to treat viral infections. JIA is not caused by viral pathogens but rather by an autoimmune dysfunction. Therefore, antiviral medications do not play a role in the primary management of juvenile idiopathic arthritis.
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