what is the priority nursing diagnosis after surgery to repair a fracture

ATI RN

Multi Dimensional Care | Final Exam

1. What is the priority nursing diagnosis after surgery to repair a fracture?

A. Disturbed body image
B. Risk for infection
C. Risk for impaired skin integrity
D. Acute pain

Correct answer: B

Rationale: The correct answer is B: Risk for infection. After surgery to repair a fracture, the priority nursing diagnosis is to monitor for the risk of infection to promote proper healing. Infections can significantly delay the healing process and lead to further complications. Choices A, C, and D are not the priority immediately post-surgery. Disturbed body image, risk for impaired skin integrity, and acute pain may be concerns but are not the priority in the immediate post-operative period following fracture repair.

2. A client has sustained an open fracture. What nursing intervention will best prevent osteomyelitis in this client?

A. Delegate all client personal care to specific unlicensed assistive personnel
B. Place the client in contact precautions
C. Proper hand hygiene
D. Administer pain medication

Correct answer: C

Rationale: Proper hand hygiene is crucial in preventing infections such as osteomyelitis in clients with open fractures. Keeping the hands clean helps reduce the risk of introducing harmful pathogens to the wound site. Delegating all client personal care to specific unlicensed assistive personnel (Choice A) is not appropriate as direct involvement in wound care is essential in preventing infections. Placing the client in contact precautions (Choice B) is not directly related to preventing osteomyelitis in this context. Administering pain medication (Choice D) is important for managing the client's pain but does not directly address the prevention of osteomyelitis.

3. What are signs of hearing loss? (Select all that apply)

A. Answering questions correctly
B. Presence of cerumen
C. Tinnitus
D. Frequent asking of others to repeat statements

Correct answer: C

Rationale: Signs of hearing loss include tinnitus, frequent asking to repeat statements, and shouting in conversations.

4. 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.