Question 1 of 6
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Which action would the nurse take when assessing a patient who arrives to the urgent care clinic with a possible fractured wrist?
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- Prepare the patient for a cast to be placed.The nurse would not prepare for a cast to be placed initially. After a fracture is confirmed, the nurse would prepare the patient for a cast or other device to immobilize the injured area. When a fracture is suspected, the nurse would treat the wrist as a fracture and splint the area. A splint is a temporary immobilization device; a cast is used long term.
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- Apply a splint to the wrist, immobilizing the injury.When a fracture is suspected, the nurse would treat the wrist as a fracture and splint the area. A splint is a temporary immobilization device; a cast is used long term.
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- Assign the problem statement for potential infection.There is no indication that the patient is currently at risk for infection. An open fracture would require the problem statement of potential for infection. When a fracture is suspected, the nurse would treat the wrist as a fracture and splint the area. A splint is a temporary immobilization device; a cast is used long term.
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- Assess the ability for the patient to perform usual activities of daily living (ADLs).The nurse would focus care on immobilizing the injury until a fracture is confirmed or ruled out. Assessing the patient’s ability to perform ADLs is not the appropriate action at this time. When a fracture is suspected, the nurse would treat the wrist as a fracture and splint the area. A splint is a temporary immobilization device; a cast is used long term.
Question 2 of 6
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Which nursing care outcome for the patient with a fracture is the nurse addressing when providing pin care to the patient being treated with external fixation?
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- Reducing the risk for infectionPin care for the patient being treated with external fixation focuses on removing serosanguineous drainage and crusting, which can lead to infection. Pin care also involves assessing for loosening. Pin care is done using sterile water and the patient should be premedicated 30 minutes before pin care.
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- Decreasing the risk for deep vein thrombosisPin care does not decrease the risk for deep vein thrombosis. Anticoagulants, compression stockings, and passive or active range of motion will decrease the risk for deep vein thrombosis. Pin care for the patient being treated with external fixation focuses on removing serosanguineous drainage and crusting, which can lead to infection.
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- Improving physical mobilityPin care does not improve physical mobility. Activities that improve physical mobility include use of assistive devices as appropriate, encouraging self-care as able, and encouraging exercises appropriate to the patient’s condition. Pin care for the patient being treated with external fixation focuses on removing serosanguineous drainage and crusting, which can lead to infection.
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- Enhancing self-carePin care does not enhance self-care. Activities that enhance self-care include encouraging the patient to do what they can for their own care, providing assistive devices to accomplish self-care, and allowing the patient extra time to perform self-care. Pin care for the patient being treated with external fixation focuses on removing serosanguineous drainage and crusting, which can lead to infection.
Question 3 of 6
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Which physical assessment is indicated as part of the focused assessment of the patient with a fractured arm? Select all that apply. One, some, or all responses may be correct.
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- Blood pressureBlood pressure is not part of the focused assessment for the patient who experienced a fracture. The blood pressure would be part of the general assessment.
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- Bilateral lung soundsBilateral lung sounds are not part of the focused assessment for the patient who experienced a fracture. The bilateral lung sounds would be part of the general assessment.
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- Sensation in the fingersSensory perception in the fingers is an appropriate focused assessment for the patient who experienced a fractured arm. Sensory perception distal to the injury assists to determine neurological effects related to injury or treatment.
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- Skin temperatureThe skin temperature is important in identifying decreased blood flow or the presence of infection. Skin temperature at the site of the injury and distally is an appropriate focused assessment for the patient with a fractured arm.
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- Pressure injury risk scoreA pressure injury risk score is not part of the focused assessment needed for the patient who has experienced a fracture. The pressure injury risk score would be a part of the general patient assessment.
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- Range of motion distal to injuryRange of motion distal to the injury is an important part of the focused assessment for the patient who has experienced a fracture. Range of motion assists to identify neurological compromise in the patient.
Question 4 of 6
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Which response would the nurse provide to the unlicensed personnel who reaches for the external hardware to assist in repositioning the patient being treated for a fracture?
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- “Be sure to use gloves if you are going to touch the external hardware device.”The nurse would not encourage the unlicensed personnel to use the external hardware to assist in repositioning the patient. These devices or brace bars are not to be used for lifting and turning the patient.
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- “Let’s ask the health care provider about how to use the external hardware for repositioning.”External hardware or brace bars between the legs of a cast are not to be used for lifting and turning the patient. The nurse would not ask the health care provider about using the external hardware for repositioning.
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- “You grab on to that area of the external hardware and I will grab onto the other end.”External hardware or brace bars between the legs of a cast are not to be used for lifting and turning the patient. The nurse would not suggest the unlicensed personnel grab one area while the nurse grabs another.
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- “Let’s move the patient with pillows for support instead of using the external hardware.”External hardware or brace bars between the legs of a cast are not to be used for lifting and turning the patient. The nurse would be acting appropriately to encourage the use of pillows to support the patient instead of using the external hardware.
Question 5 of 6
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Which nursing education would the nurse provide to the patient whose fractured ankle will be treated with placement of a cast? Select all that apply. One, some, or all responses may be correct.
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- Use a hair dryer on the cool setting to manage any itching under the cast.Patients may want to scratch the skin surface under the cast. They should avoid placing anything under the cast such as rulers or pencils. Instead, the use of a hair dryer on a low setting is helpful to address the need to scratch the area.
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- Avoid handling the cast with your fingers for the first 48 hours.During the first 48 hours when the cast is drying, the patient and any caregivers should avoid handling the cast with their fingers. Instead, using the flat surfaces of their palms is preferred to avoid putting indentations into the cast, potentially causing pressure points.
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- Use large ice packs on top of the cast to reduce the heat produced while drying.It is not appropriate to use ice packs to manage the heat produced while the cast is drying. Instead, small ice bags propped against the cast are used to manage any swelling. Ice bags should not be placed on top of the cast.
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- Report any cracking or soft spots in the cast to your health provider.Cracking or soft spots in the cast suggest the integrity of the cast is compromised and must be reported to the health provider.
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- Expect your skin to be dry and scaly once the cast is removed.Once a cast is removed, the skin is usually scaly and dry. The patient should be informed of this expected finding and encouraged to avoid scrubbing the area, instead, allowing the skin to slough naturally.
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- Keep the ankle elevated for at least the first 48 hours after the cast is applied.Elevating the extremity for 24 to 48 hours after any cast has been applied is important to reduce swelling.
Question 6 of 6
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Which outcome suggests that the nurse needs to revise the plan of care for the patient who has experienced a fracture?
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- The patient performs activities of daily living (ADLs) independently using assistive devices.When the patient is performing ADLs independently, even with assistive devices, the plan of care is effective and does not need to be revised. If the patient were not able to perform ADLs independently, even with assistive devices, the plan of care would need to be revised.
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- The patient experiences constipation 1 to 2 times weekly.Experiencing constipation suggests the patient continues to struggle with problems related to immobility, and the plan of care should be revised to address care needs.
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- The patient manages pain using over-the-counter medication.Managing pain demonstrates the patient’s plan of care is effective and does not need revised. If the pain becomes out of control, then the plan would need to be revised.
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- The patient is gradually increasing walking distance each day.The patient who is gradually increasing their walking distance each day is demonstrating effective mobility and does not need the plan revised. If the patient’s mobility decreased, the plan of care would need to be revised.