a nurse is caring for a client who is post operative following an open reduction internal fixation orif of a femur fracture what is not included in t

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. A nurse is caring for a client who is post-operative following an open reduction internal fixation (ORIF) of a femur fracture. What is NOT included in the evaluation of the neurovascular status of the client's affected extremity?

A. Color
B. Temperature
C. Sensation
D. Skin integrity

Correct answer: D

Rationale:

2. A nurse is caring for a client who has acute osteomyelitis. Which of the following interventions is the nurse's priority?

A. Administer antibiotics to the client
B. Increase the client's protein intake
C. Teach relaxation breathing to reduce the client's pain
D. Provide the client with anti-pyretic therapy

Correct answer: A

Rationale:

3. A client has a fractured right arm. What should the nurse do first?

A. Apply ice to the fracture site
B. Administer pain medications
C. Remove the client’s bracelet and rings from the right arm
D. Send the client to radiology for an x-ray

Correct answer: C

Rationale: The nurse should first remove the client's bracelet and rings from the right arm. This action is crucial to prevent complications such as swelling and restricted blood flow, which could worsen the condition. Applying ice, administering pain medications, and sending the client for an x-ray are important steps but should come after ensuring the client's jewelry is removed to avoid any further issues.

4. A client does not understand why vision loss due to glaucoma is irreversible. What is the best explanation?

A. Once bacterial infection has caused damage, the tissue does not regenerate.
B. Once retinal detachment occurs, it does not return to its normal state.
C. Too many nerve fibers have become ischemic and died, so vision loss is permanent.
D. Glaucoma always leads to permanent blindness.

Correct answer: C

Rationale: The correct answer is C. In glaucoma, the optic nerve damage due to high intraocular pressure leads to permanent vision loss because the nerve fibers do not regenerate. Choice A is incorrect as it discusses bacterial infection, not relevant to glaucoma. Choice B is incorrect because it refers to retinal detachment, not glaucoma. Choice D is incorrect because not all glaucoma cases lead to permanent blindness; vision loss can be prevented or slowed with treatment.