The practical nurse (PN) is monitoring a 5-year-old following a fracture of the ulna. For which situation should the PN seek immediate intervention by the registered nurse (RN)?
The child likes to wiggle the fingers on the hand of the affected side.
The child's radial pulse volume on the affected arm is difficult to palpate.
An accurate respiratory rate cannot be measured because of the child's crying.
The parents of the child are requesting that the child receive an analgesic.
The Correct Answer is B
This could indicate reduced blood flow to the affected arm, which may be a sign of compartment syndrome. Compartment syndrome is a serious condition that requires immediate intervention by a registered nurse (RN). The other options may also require intervention, but they are not as urgent as the situation described in option B.
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Related Questions
Correct Answer is B
Explanation
The information that poses the greatest risk for developing postpartum endometritis in this situation is that the client experienced spontaneous rupture of membranes (SROM) for 36 hours prior to delivery. SROM for an extended period of time increases the risk of infection, including postpartum endometritis, which is an infection of the uterus. The practical nurse (PN) should recognize this risk factor and monitor the client closely for signs of infection. The other information listed may also be important to consider, but SROM for 36 hours poses the greatest risk for developing postpartum endometritis in this situation.
Correct Answer is B
Explanation
Placenta previa is a condition in which the placenta partially or completely covers the cervix, which can lead to vaginal bleeding during pregnancy. In severe cases, this bleeding can be life-threatening and can lead to hemorrhage. Therefore, the PN should closely monitor the client for any signs of bleeding or hemorrhage, such as excessive vaginal bleeding, hypotension, tachycardia, or signs of shock. The PN should also ensure that the client receives appropriate medical interventions and that emergency measures are in place in case of sudden bleeding or hemorrhage.
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