the nurse is preparing communication for a provider the client is experiencing acute pain greater than the severity of the fracture distal to the inju

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. The nurse is preparing communication for a provider. The client is experiencing acute pain greater than the severity of the fracture. Distal to the injury, he is experiencing a 'pins and needles' sensation. The pulse is weak and thready but is bounding on all unaffected extremities. What emergent condition does the nurse suspect?

A. Ischial tuberosity
B. Compartment syndrome
C. Broken arm syndrome
D. Pulmonary embolism

Correct answer: B

Rationale:

2. 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.

3. The nurse suspects a 3-year-old who is coughing vigorously has aspirated a small object. Which action should the nurse take?

A. Deliver upward abdominal thrusts with a fisted hand
B. Perform a blind finger sweep of the child's mouth
C. Complete five rapid back blows between the shoulder blades
D. Encourage the child to continue coughing

Correct answer: D

Rationale:

4. The client moves both crutches forward, with weight on the unaffected leg, and then moves the unaffected leg forward, shifting weight onto it. Which of the following gaits is being utilized?

A. Two-point gait
B. Three-point gait
C. Four-point gait
D. Unaffected gait

Correct answer: B

Rationale: The correct answer is B, Three-point gait. In a three-point gait, one leg is non-weight bearing, as described in the scenario where the client shifts weight onto the unaffected leg. Choices A, C, and D are incorrect. A two-point gait involves partial weight-bearing on both legs, a four-point gait involves weight-bearing on both legs, and 'Unaffected gait' is not a recognized term in gait patterns.