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. The nurse is most concerned about which of these findings in a client with systemic lupus erythematous?

A. The client reports chronic fatigue
B. The client has a butterfly rash
C. Blood pressure of 126/85 mm Hg
D. Urine output of 20 mL/hour

Correct answer: D

Rationale:

3. What may be a cause of conductive hearing loss?

A. Prolonged exposure to loud noises
B. Medications
C. Presbycusis
D. Otitis media

Correct answer: D

Rationale: Otitis media can cause conductive hearing loss by affecting the middle ear.

4. Which of the following assessments is found in neurovascular compromise?

A. Tingling
B. Strong pulses
C. Warm skin
D. Full range motion

Correct answer: A

Rationale: Tingling is a common sign of neurovascular compromise.

5. What should be done immediately after an ankle injury?

A. Immobilize, heat, compress, and elevate the ankle
B. Rest, ice, compress, and lower the ankle
C. Rest, ice, compress, and elevate the ankle
D. Rest, incubate, confine, and lower the ankle

Correct answer: C

Rationale: The correct answer is C: Rest, ice, compress, and elevate the ankle. After an ankle injury, it is essential to follow the RICE method (Rest, Ice, Compression, Elevation) for immediate treatment. Resting the injured ankle helps prevent further damage, applying ice reduces swelling and pain, compression with a bandage provides support and helps control swelling, and elevating the ankle above heart level reduces swelling by allowing fluid to drain away from the injury site. Choices A, B, and D are incorrect because heating, incubating, or confining the ankle can worsen the injury by increasing swelling and inflammation instead of reducing them.