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A client is experiencing numbness and tingling distal to a new arm cast with no increase in pain. The nurse assesses that the client's fingers are pale, cool, and swollen. What action does the nurse take next?

Choice A reason: This is an unrealistic and unattainable goal for a client with rheumatoid arthritis. Rheumatoid arthritis is a chronic and progressive inflammatory disease that causes joint pain, stiffness, swelling, and deformity. It is not possible to eliminate pain completely with this condition. The nurse should help the client set realistic and individualized goals for pain management.

Choice B reason: This is a vague and subjective goal for pain control. Pain is a personal and multidimensional experience that varies from person to person. The nurse should use a valid and reliable pain assessment tool, such as the numeric rating scale, to measure the client's pain intensity and quality. The nurse should also ask the client about their acceptable level of pain and how it affects their daily activities and quality of life.

Choice C reason: This is a good goal for general health and wellness, but it is not specific to pain control. Eating healthy meals and staying hydrated can help the client maintain their nutritional status and hydration, which are important for overall health. However, they do not directly address the pain caused by rheumatoid arthritis. The nurse should also consider other factors that can influence pain, such as stress, mood, sleep, and coping strategies.

Choice D reason: This is the best goal for pain control in a client with rheumatoid arthritis. It is realistic, measurable, and individualized. It acknowledges that some pain is inevitable with this condition, but it aims to reduce it to a tolerable level that allows the client to function and enjoy life. It also uses a numeric rating scale to quantify the pain and monitor the effectiveness of interventions.

Choice A reason: A bone fragment has injured the nerve supply in the area is not the best response by the nurse. This may be a possible complication of a fracture, but it does not explain the mechanism of compartment syndrome. Compartment syndrome is a condition where the pressure within a closed space (such as a muscle compartment) exceeds the perfusion pressure and causes ischemia and necrosis of the tissues. A bone fragment may damage the nerve, but it does not cause increased pressure in the compartment.

Choice B reason: An injured artery causes impaired arterial perfusion through the compartment is not the best response by the nurse. This may be a possible cause of compartment syndrome, but it is not the most common one. Compartment syndrome is more often caused by venous obstruction than arterial obstruction. An injured artery may reduce the blood flow to the compartment, but it does not cause increased pressure in the compartment.

Choice C reason: Bleeding and swelling cause increased pressure in an area that cannot expand is the best response by the nurse. This is the most common cause of compartment syndrome and explains the pathophysiology of the condition. Bleeding and swelling are the result of inflammation and tissue injury that occur after a fracture. They increase the volume of fluid in the compartment, which cannot expand due to the rigid fascia that surrounds it. This leads to increased pressure in the compartment, which compresses the blood vessels, nerves, and muscles and causes ischemia and necrosis of the tissues.

Choice D reason: The fascia expands with injury, causing pressure on underlying nerves and muscles is not the best response by the nurse. This is not a correct statement, as the fascia does not expand with injury. The fascia is a tough connective tissue that encloses the muscle compartments and limits their expansion. The fascia is part of the problem, not the cause, of compartment syndrome. The fascia prevents the compartment from accommodating the increased volume of fluid and causes increased pressure in the compartment.