What four further assessments of the leg injury are needed?
Assess range of motion.
Ask Mike to stand to assess if he can bear weight.
Assess skin color of the lower leg.
Assess paresthesia.
Assess pain.
Assess pulses of the lower leg.
Correct Answer : C,D,E,F
Choice A rationale
Assessing the range of motion of a severely injured leg is not appropriate during initial evaluation. Movement can worsen the injury or disrupt stabilizing measures such as splints or dressings.
Choice B rationale
Asking the patient to stand or bear weight risks further injury and is contraindicated in cases of visible deformity or massive bleeding.
Choice C rationale
Evaluating skin color helps identify potential ischemia, vascular compromise, or inadequate perfusion. Pallor or cyanosis can indicate significant circulation issues needing urgent care.
Choice D rationale
Paresthesia (tingling or numbness) reflects nerve function and can reveal nerve damage or compromised blood flow, necessitating thorough evaluation.
Choice E rationale
Pain assessment is crucial for identifying the severity of injury and potential complications such as compartment syndrome. Pain disproportionate to the injury suggests complications.
Choice F rationale
Palpating pulses assesses blood flow, ensuring the presence of distal perfusion. Absent or weak pulses require urgent vascular intervention to prevent tissue necrosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Mixing insulin glargine and lispro in the same syringe is contraindicated due to their incompatible chemical formulations. Glargine’s acidic pH alters lispro’s effectiveness when mixed, impairing glycemic control. Separate administration preserves their individual pharmacokinetics and therapeutic actions.
Choice B rationale
Separate injections ensure each insulin maintains its unique action profile. Glargine provides basal control, while lispro manages rapid postprandial spikes. Their chemical incompatibility mandates separate administration, optimizing glycemic management and reducing potential adverse effects from mixed formulations.
Correct Answer is D,B,E,A,C
No explanation
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