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
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Nursing Elites

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?

Correct answer: B

Rationale:

2. A wound has a blood-tinged liquid that is dripping from the surgical site. How does the nurse document this finding?

Correct answer: C

Rationale:

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

Correct answer: A

Rationale: Tingling is a common sign of neurovascular compromise.

4. What observation by the nurse indicates the need for further teaching to unlicensed assistive personnel (UAP) on assisting with ambulation?

Correct answer: C

Rationale: Choice C is the correct answer because the UAP should walk slightly behind or to the side of the client, not in front, to provide proper support during ambulation. Choices A, B, and D are not indicative of incorrect technique or the need for further teaching. Putting shoes on the client, removing floor rugs and loose objects, and using a transfer (gait) belt are all appropriate actions when assisting with ambulation.

5. What health teaching would not help an older adult avoid a musculoskeletal injury?

Correct answer: A

Rationale: Avoiding home modifications can increase the risk of falls and injuries in older adults.

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