A nurse is caring for an adolescent following the application of a plaster cast for a fractured right tibia.
Which of the following actions should the nurse take?
Discourage the client from ambulating.
Keep the client's leg in a dependent position.
Use a hair dryer on a hot setting to dry the cast.
Perform a neurovascular check of the lower extremities.
The Correct Answer is D
Choice A rationale
Discouraging the client from ambulating is not necessary. In fact, early ambulation is often encouraged to promote circulation and prevent complications, depending on the fracture
type and treatment plan.
Choice B rationale
Keeping the client's leg in a dependent position is not recommended as it can increase swelling and pain. Elevating the leg is typically advised to reduce swelling.
Choice C rationale
Using a hair dryer on a hot setting to dry the cast is unsafe as it can cause burns and damage the cast. It's better to allow the cast to dry naturally and follow the healthcare provider's
instructions.
Choice D rationale
Performing a neurovascular check of the lower extremities is crucial to assess circulation, sensation, and movement. This helps in identifying any complications such as impaired
blood flow or nerve damage.
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View Related questions
Correct Answer is D
Explanation
A. Elevated blood pressure is not an indication of dehydration; dehydration is more likely to cause a drop in blood pressure due to decreased blood volume.
B. Dehydration typically does not cause a low body temperature; instead, it can lead to an elevated temperature as the body conserves water.
C. Jugular vein distention is associated with fluid overload or heart failure, not dehydration.
D. Skin tenting, where the skin remains elevated after being pinched, is a classic sign of dehydration due to reduced skin elasticity.
Correct Answer is C
Explanation
Choice A rationale
Performing ROM exercises can cause stress on the infant's developing bones and muscles and is not the priority for spina bifida.
Choice B rationale
Feeding through an NG tube is not necessary unless the infant has feeding difficulties related to spina bifida.
Choice C rationale
Placing the infant in a prone position prevents pressure on the lesion, reducing the risk of injury and infection.
Choice D rationale
Covering the lesion with a dry cloth can cause the area to dry out and is not recommended; sterile, moist dressings are preferred.