You are working evenings on an orthopedic floor. One of your patients, J.O., is a 25-year-old man who was
a new admission on day shift. He was involved in a motor vehicle accident during a high-speed police
chase on the previous night.
His admitting diagnosis is status post (S/P) open reduction internal fixation
(ORIF) of the right femur, multiple rib fractures, sternal bruises, and multiple abrasions. He speaks some
English but is more comfortable with his native language. He is under arrest for narcotics trafficking, so
one wrist is shackled to the bed and a guard is stationed inside his room continuously. He says a drug
dealer told him he is "coming to get him." Hospital security is aware of the situation.
Your initial assessment reveals stable vital signs (VS) of 116/78, 84, 16, 98.6° F. His only complaint is
pain, for which he has a patient-controlled analgesia (PCA) pump. Lungs are clear to auscultation. His
abdomen is soft and nontender. He has a nasogastric tube connected to intermittent low wall suction.
He is receiving IV D5LR through the proximal port of a left subclavian triple-lumen catheter at 75 mL/hr;
the remaining two ports are locked. The right femur is connected to 10 pounds of skeletal traction. The
dressing is dry and intact over the incision site.
J.O. has not had a cigarette since the accident. He is irate because the day nurse would not
let him smoke. Do you think J.O. would be a good candidate for a nicotine patch? State your
rationale.
No. It is unlikely that the managing physician will order a nicotine patch because the nicotine in the
patch is associated with adverse effects that can have an impact on J.O.'s condition. His evidence of
chest trauma, general anesthesia, smoking history, crackles in both bases, and the traction-enforced
bed rest put J.O. at high risk for postoperative pulmonary complications. He is at high risk for a
thromboembolus related to prolonged bed rest and a fat embolus related to his fractured femur.
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Patients immobilized because of spinal trauma are at a high risk for contractures. Preventive measures should include (Select all that apply.)
a. consultation by PT and OT early in the treatment of the patient. b. turning and repositioning the patient every 2 hours as ordered by the physician. c. range of motion exercises 1 month after the spine has been stabilized. d. removal of splints every 4 hours and at bedtime. e. hand splints for patients with paraplegia. f. hand and foot splints for patients with quadriplegia.
A patient has been prescribed a topical corticosteroid and the nurse is providing relevant patient teaching about the correct technique for applying this medication. What guideline should the nurse provide to this patient?
A) Apply the medication to the affected area and to unaffected skin within 2 to 3 inches of the affected skin. B) Apply a thin coating of the medication, but ensure that all affected areas are covered with the medication. C) Avoid covering affected areas with clothing or bandages after applying the medication. D) Apply a coating of the medication to the affected area and then gently rub it off after 5 to 10 minutes.
A patient, recovering from a laparoscopic cholecystectomy one day ago, has an increased gastric carbon dioxide level and decreased arterial pH. Even with an indwelling urinary catheter, the nurse questions if the bladder is emptying
Which of the following orders should the nurse question regarding the care of this patient? 1. insert urinary catheter to assist in monitoring intra-abdominal pressure 2. prepare for surgery to place catheter into peritoneal cavity 3. keep head of bed elevated 30 degrees at all times 4. utilize urinary catheter to assist in monitoring intra-abdominal pressure
Public health nurses serve their communities in a variety of ways. Which is an example of primary prevention for a community?
A) Implementation of a psychiatric home health care program B) Further development of a partial hospitalization program C) Money-management counseling for couples with compulsions to spend D) Intervening with a high-risk population to decrease incidence of conduct disorder