pop Quiz 3

A client with multiple fractures is admitted to the hospital. What is a nurse in the proficient stage expected to do in this situation?

Coordinate with all the appropriate members of the healthcare team when providing client care. A nurse who has reached the proficient stage is able to assess an entire situation and transfer knowledge gained from multiple past experiences. Because this nurse focuses on managing care, the nurse is expected to coordinate with all the appropriate members of a healthcare team to provide proper client care. An expert-level nurse is able to look at a situation intuitively; in this case, a nurse at this level is expected to assess the client for potential complications related to multiple fractures. A nurse at the competent stage is able to understand the organization and specific care required for the type of client in question; in this case, the nurse is expected to understand that the client requires orthopedic care and should be transferred to the orthopedic unit for proper treatment. A nurse at the advanced beginner level is expected to identify the basic principles of providing orthopedic care. However, a nurse of a higher level should provide client care.

After a client with multiple fractures of the left femur is admitted to the hospital for surgery, the client demonstrates cyanosis, tachycardia, dyspnea, restlessness, and petechiae on the chest. What should the nurse do first?

Administer Oxygen Vital signs should be done after oxygen administration. Obtaining vital signs will delay an intervention that may help reduce the client's distress. The client probably has a fat embolus; oxygen reduces the surface tension of fat globules, reducing hypoxia. Interventions should be initiated to help the client before taking the time to notify the healthcare provider. Placing the client in the high-Fowler position will cause hip flexion, putting stress on the fractured femur; the low or semi-Fowler positions are preferred.

A 90-year-old resident of a nursing home falls and fractures the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. What general fact about the older adult should the nurse consider when caring for this client?

Physiologic coping defenses are reduced. Aging causes a lowering of the physiologic coping reserve of various systems of the body. The pain threshold increases with aging. There are many etiologies for confusion (e.g., drug intolerance, altered metabolic state, unfamiliar surroundings). As individuals age they become more entrenched in ideas, environment, and objects that are familiar, and thus do not tolerate change well. Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question.

A 2-year-old child is admitted with multiple fractures and bruises, and abuse is suspected. Which nursing assessment findings support this suspicion? Select all that apply.

difficulty consoling, underdevelopment for AGE Abused children may be difficult to console because they have not had positive past interpersonal experiences. Failure to thrive is often seen in abused children. It results from emotional stress, as well as from neglect of physical needs. The task of nighttime bladder training may not be completed until 4 or 5 years of age, and sometimes even later. Thumb-sucking is not noteworthy because many children, not just those who are abused, continue to suck their thumbs for several years. Abused children do not seek physical closeness because their needs for comfort have not been met in the past.

Which hormonal deficiency would increase the clients risk for fractures?

growth hormone growth hormone deficiency causes decrease in bone density, thereby increasing the risk of fractures. follicle stimulating hormone deficiency causes amenorrhea, decreased libido, and infertility in women and impotence in men, Thyroid-stimulating hormone deficiency causes menstrual abnormalities and hirsutism. Adrenocorticotropic hormone deficiency causes hypoglycemia and hyponatremia.

After a lateral crushing chest injury, obvious right-sided paradoxical motion of a client's chest demonstrates multiple rib fractures, resulting in a flail chest. Which complication associated with this injury should the nurse assess in this client?

mediastinal shift Mediastinal structures move toward the uninjured lung, reducing oxygenation and venous return. Tracheal laceration is unlikely with a crushing injury to the chest. Flail chest is a closed chest injury; open pneumothorax results from a penetrating injury to the chest wall. Pericardial tamponade is associated with a cardiac contusion and usually occurs from a sternal, not lateral, compression injury.

A client is admitted with posttraumatic brain injury and multiple fractures. The client's eyes remain closed, and there is no evidence of verbalization or movement when the nurse changes the client's position. What score on the Glasgow Coma Scale (GCS) should the nurse document? Record your answer using a whole number. _______ Total GCS score

3 The score is 3. The score on the GCS ranges from 3 to 15. The client's lack of response earns the minimum of one point in each of the categories: eye opening response, best verbal response, and best motor response.

A 19-year-old adolescent is admitted to the emergency department with multiple fractures and potential internal injuries. The client's history reveals multiple drug abuse for the past 8 months. When caring for this client, the nurse determines that the most serious life-threatening responses usually result from withdrawal from which drug?

Barbiturates Withdrawal from central nervous system such as barbiturates, is associated with more severe morbidity and mortality. Symptoms begin with anxiety, shakiness, and insomnia; within 24 hours convulsions, delirium, tachycardia, and death may occur. Withdrawal from heroin or methadone is rarely life threatening, but it does cause severe discomfort, including abdominal cramping and diarrhea. Withdrawal from amphetamines is rarely life threatening, but it causes severe exhaustion and depression.

A 7-year-old child sustains a fractured femur in a bicycle accident. The admission x-ray films reveal evidence of fractures of other long bones in various stages of healing. What does the nurse suspect as the cause of the fracture?

Child abuse Injuries in various stages of healing are the classic sign of child abuse. Vitamin D deficiency, osteogenesis imperfecta, and inadequate calcium intake may all be investigated after child abuse has been ruled out. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.

A 20-year-old carpenter falls from a roof and sustains fractures of the right femur and left tibia. The client reveals a history of substance abuse. What is the primary consideration for the nurse who is caring for this client?

Determining the amount and time of last use of the substance Determining the amount and last use of the substance is the priority. Nurses should base their treatment of withdrawal symptoms on the time and amount of last use. Confronting the client is not the nurse's responsibility at this time. The client must be helped to recognize that a problem with drugs exists, but this is not the priority. Because of cross-tolerance the client may need larger doses of analgesia for pain relief than a nonabuser would, but this is not the priority.

After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac arrest, therapeutic hypothermia is ordered. Which action will the nurse include in the plan of care?

Initiate cooling per protocol. When therapeutic hypothermia is used postresuscitation, external cooling devices or cold normal saline infusions are used to rapidly lower body temperature to 89.6° F to 93.2° F (32° C to 34° C). Because hypothermia will decrease brain activity, assessing mental status every 15 minutes is not done at this stage. Sedative drugs are given during therapeutic hypothermia.