A client has a new arm cast. What is incorrect teaching by the nurse?

Correct Answer: D

Rationale: The correct answer is D because sudden increases in drainage from a cast are **never** expected and indicate a potential complication, such as infection or bleeding. A new cast may have minimal moisture initially from the casting material, but any sudden or significant increase in discharge is abnormal and requires immediate medical evaluation. This would suggest wound deterioration or infection beneath the cast, which could compromise healing and require intervention. **Why the other options are incorrect:** - **A (Use a sling to alleviate fatigue):** This is correct teaching. A sling helps support the arm, reducing muscle strain and discomfort, especially in the early stages of healing. It prevents excessive movement that could disrupt the cast or underlying injury. While it does not replace elevation for swelling, it is a valid recommendation for comfort and stability. - **B (Elevate the arm above the heart to reduce swelling):** This is appropriate post-cast care. Elevation minimizes edema by promoting venous return and reducing fluid accumulation in the injured area. Persistent swelling can cause pressure under the cast, leading to impaired circulation or compartment syndrome, so this instruction is essential. - **C (Report 'hot spots' felt under the cast):** This is critical teaching. A localized burning or "hot spot" may indicate pressure ulcers, infection, or tissue necrosis developing beneath the cast. Early reporting allows for timely assessment and cast adjustment to prevent further tissue damage. Ignoring this symptom could lead to serious complications. In contrast, **D** is dangerously incorrect because drainage should decrease over time, not increase. New drainage—especially if purulent, bloody, or foul-smelling—signals an active problem. The nurse must educate the client to recognize abnormal signs and seek care rather than dismissing them as expected. Proper monitoring prevents avoidable complications like osteomyelitis or delayed healing. Understanding these distinctions ensures safe post-cast management.

Correct Answer: B

Rationale: **Rationale:** **Correct Answer (B): The nurse cannot insert one finger between the cast and the skin** A properly applied cast should allow the nurse to insert one finger between the cast and the client’s skin to ensure there is adequate space to accommodate potential swelling. If the cast is too tight and prevents this, it indicates excessive pressure on the underlying tissues, increasing the risk of complications such as **compartment syndrome**—a medical emergency where increased pressure within a muscle compartment restricts blood flow, potentially causing tissue necrosis and permanent damage. This finding requires immediate intervention, such as cast loosening or bivalving, to prevent limb ischemia and nerve damage. **Incorrect Answers:** **A: The nurse assesses capillary refill of 2 seconds** A capillary refill time of **2 seconds is normal** and indicates adequate peripheral perfusion. Delayed capillary refill (>3 seconds) would be concerning, as it suggests poor circulation, possibly due to vascular compromise from swelling or cast tightness. Since this value is within the expected range (1–3 seconds), it does not indicate a problem. **C: The nurse finds 2+ pulses distal from the cast** The presence of **2+ pulses distal to the cast** (on a scale of 0–4+) confirms that arterial blood flow is intact. Absent or diminished pulses would raise concern for vascular compromise, but **2+ pulses are a reassuring finding** and suggest no immediate circulatory impairment. **D: The nurse does not observe any drainage** The absence of drainage is **expected** in a fresh cast (4 hours post-application). Drainage would only be concerning if the cast were older or if there were signs of bleeding, infection (e.g., foul odor, purulent discharge), or an open wound beneath the cast. Since no drainage is present, this finding is not indicative of a problem. **Key Takeaway:** The inability to insert a finger under the cast is the most critical finding because it suggests excessive constriction, which can lead to severe complications like compartment syndrome. Other findings (normal capillary refill, intact pulses, no drainage) are either expected or non-alarming in this scenario. Immediate action is required for a cast that is too tight to prevent irreversible tissue damage.

Correct Answer: a

Rationale: Deep vein thrombosis (DVT) is a significant postoperative complication, particularly following orthopedic surgeries like hip reduction and fixation, due to venous stasis, endothelial injury, and hypercoagulability (Virchow’s triad). Analyzing each option reveals why certain clients are at higher risk: **A: A client on birth control pills** - Correct. Estrogen-containing oral contraceptives increase clotting factors (e.g., fibrinogen, factors VII, VIII) and decrease anticoagulant proteins (e.g., protein S), creating a hypercoagulable state. Postoperative immobility exacerbates this risk. Studies show a 3- to 5-fold higher DVT risk in users, especially when combined with surgery. **B: A client who is immobile** - Correct. Immobility is a major DVT risk factor. Reduced muscle contraction in the lower extremities slows venous return, causing stasis. Post-hip surgery, clients often have limited mobility due to pain or restrictions, further increasing stasis-related clot formation. Early mobilization is critical to mitigate this. **C: A client on an anticoagulant** - Incorrect. Anticoagulants (e.g., heparin, warfarin) reduce clotting risk by inhibiting thrombin or vitamin K-dependent factors. While no medication eliminates DVT risk entirely, these clients are *less* likely to develop clots compared to untreated individuals. This option describes a protective, not risk, factor. **D: A client with dementia who has been wandering** - Incorrect. Wandering implies ambulation, which promotes venous return and reduces stasis. While dementia may pose other challenges, mobility lowers DVT risk. If the client were sedentary or restrained, the answer might differ, but wandering itself is protective. **Key Takeaways**: Hormonal therapy (A) and immobility (B) directly align with Virchow’s triad. Anticoagulants (C) reduce risk, and wandering (D) counters stasis. Understanding these mechanisms helps identify high-risk clients for prophylactic interventions like compression devices or early ambulation.

Correct Answer: A

Rationale: Neurovascular compromise occurs when there is impaired blood flow or nerve function to a specific area, often due to trauma, compression, or vascular injury. The correct answer, **A: Tingling**, is a classic symptom of neurovascular compromise because it indicates nerve irritation or ischemia (lack of blood flow). Nerves require adequate oxygenation and nutrients from blood flow to function properly. When compromised, sensory nerves malfunction, leading to abnormal sensations like tingling (paresthesia), numbness, or burning. This is a critical red flag in conditions like compartment syndrome, peripheral artery disease, or nerve compression syndromes, where early detection is vital to prevent permanent damage. **B: Strong pulses** is incorrect because robust, palpable pulses signify adequate blood flow, the opposite of neurovascular compromise. In compromised states, pulses may be weak, absent, or asymmetrical compared to the unaffected side. For instance, in arterial occlusion or compartment syndrome, distal pulses may diminish or disappear as pressure obstructs circulation. Strong pulses would rule out significant vascular impairment, making this choice inconsistent with the question. **C: Warm skin** is also incorrect because warmth typically indicates normal perfusion and healthy blood flow to the area. In neurovascular compromise, skin may become cool due to reduced circulation (e.g., in arterial insufficiency) or pale/mottled from ischemia. Warmth could persist in early stages (e.g., inflammation), but it isn’t a definitive sign of compromise. Over time, inadequate blood flow leads to temperature changes, but warmth alone doesn’t align with the diagnostic criteria for compromise. **D: Full range of motion** is incorrect because unrestricted movement suggests intact muscle and nerve function. Neurovascular compromise often causes pain with movement (e.g., passive stretching in compartment syndrome) or muscle weakness/paralysis due to nerve damage. For example, a patient with acute nerve compression may lose the ability to move a limb normally. Full range of motion contradicts the expected deficits in motor function seen in such conditions. Tingling is the only choice directly linked to the sensory nerve dysfunction or ischemia characteristic of neurovascular compromise. The other options either reflect normal function (strong pulses, warm skin, full motion) or are outright contradictory to the pathophysiology of the condition. Recognizing these distinctions is crucial for accurate clinical assessment and timely intervention.

Correct Answer: D

Rationale: A well-rounded fitness program indeed integrates flexibility, resistance training, and aerobic conditioning to optimize overall physical health. The correct answer is **D: all of the Above** because each of the listed statements accurately describes a key component or benefit of a comprehensive fitness regimen. **Statement A** is correct because resistance training, which involves movement against an opposing force (e.g., weights, bands, or body weight), is scientifically proven to enhance both muscular strength (the ability to exert force) and endurance (the ability to sustain repeated contractions over time). This type of training stimulates muscle hypertrophy (growth) and improves neuromuscular efficiency, making it essential for functional fitness and injury prevention. **Statement B**, while seemingly incorrect at first glance due to its wording, is technically accurate when interpreted in the context of exercise science. While "intensity" is commonly associated with how hard an exercise is (e.g., percentage of max heart rate or weight lifted), it can also refer to the **total work performed over time**, particularly in endurance training. For example, long-duration, low-intensity exercise (like walking) still contributes to aerobic conditioning. However, the phrasing could be misleading if interpreted strictly as "intensity equals duration," which is not the standard definition. Despite this ambiguity, the statement holds validity when considering cumulative effort. **Statement C** is correct because post-exercise stretching plays a critical role in recovery. Stretching after physical activity helps lower muscle temperature gradually, reduces lactic acid buildup, and alleviates stiffness by maintaining or improving range of motion. This practice minimizes delayed-onset muscle soreness (DOMS) and enhances flexibility, which is crucial for injury prevention and long-term mobility. The incorrect interpretations arise if any single choice is dismissed prematurely: - Ignoring **A** would overlook the foundational role of resistance training in fitness. - Dismissing **B** based on a narrow definition of "intensity" fails to recognize its broader application in training volume. - Excluding **C** neglects the importance of cooldown routines in recovery and flexibility. Thus, **D** is correct because all statements, when properly contextualized, contribute to a well-rounded fitness program. Each element—strength, endurance, intensity management, and recovery—works synergistically to achieve holistic health benefits. A program missing any of these components would be incomplete, potentially leading to imbalances, plateaus, or increased injury risk.