The nurse is assessing a client who had a cast placed 4 hours ago. What assessment finding is cause for concern?

Correct Answer: B

Rationale: Let’s analyze each option in detail to understand why **B** is the correct answer and why the others are incorrect. **Option B: The nurse cannot insert one finger between the cast and the skin** This is the correct answer because a properly applied cast should allow for slight swelling while maintaining immobilization. If the nurse cannot insert a finger between the cast and the skin, it indicates that the cast is **too tight**, which can lead to serious complications such as **compartment syndrome**. This condition occurs when increased pressure within a confined space (caused by swelling) restricts blood flow, potentially leading to tissue necrosis and permanent damage. Nurses must ensure there is enough space to accommodate expected post-cast swelling, and inability to insert a finger is a critical warning sign requiring immediate intervention, such as cast loosening or replacement. **Option A: The nurse assesses capillary refill of 2 seconds** A capillary refill time of **2 seconds is normal** and indicates adequate peripheral circulation. Delayed capillary refill (>3 seconds) would be concerning, as it suggests poor perfusion, possibly due to vascular compression or compromised circulation. Since 2 seconds falls within the expected range, this finding does not raise immediate concerns and is not the correct answer. **Option C: The nurse finds 2+ pulses distal from the cast** A **2+ pulse** is considered **normal** and indicates sufficient blood flow to the extremity. Diminished or absent pulses (0 or 1+) would be problematic, signaling possible vascular compromise, such as arterial occlusion or severe swelling obstructing circulation. Since 2+ pulses are expected in a healthy assessment, this finding does not warrant concern. **Option D: The nurse does not observe any drainage** The absence of drainage is typically **a normal and expected finding** in a fresh cast (unless there was an open wound pre-cast application). Drainage or foul odor would suggest complications like **infection or hemorrhage**, requiring further evaluation. Since no drainage is not a worrisome sign, this option is incorrect. In summary, **B** is the only choice indicating a potential **dangerous complication (cast tightness leading to impaired circulation or compartment syndrome)**, whereas the other findings are either normal or do not suggest immediate risk. Proper cast assessment prioritizes checking for tightness, circulation, sensation, and movement—any restriction in these areas must be addressed promptly to prevent permanent damage.

Correct Answer: B

Rationale: **Rationale:** **Correct Answer (B): Reducing caffeine intake can decrease the risk of osteoporosis.** Caffeine has a mild diuretic effect, increasing calcium excretion through urine. Over time, excessive caffeine consumption (typically >3–4 cups of coffee per day) may contribute to decreased bone mineral density, particularly if calcium intake is insufficient. While caffeine alone is not a primary cause of osteoporosis, moderation helps preserve calcium balance, supporting bone health. **Incorrect Answer (A): Avoiding vitamin D would increase, not decrease, osteoporosis risk.** Vitamin D is essential for calcium absorption in the intestines. Without sufficient vitamin D, the body cannot effectively utilize dietary calcium, leading to weakened bones. Avoiding vitamin D would exacerbate bone loss, directly contradicting osteoporosis prevention strategies. **Incorrect Answer (C): Decreasing alcohol intake is correct, but the question asks for the nurse’s incorrect statement.** Excessive alcohol impairs osteoblast function (bone-forming cells) and interferes with calcium and vitamin D metabolism, increasing osteoporosis risk. However, this option is factually accurate, so its inclusion here suggests a misinterpretation of the question. If the question intended to identify only incorrect statements, this would not fit. **Incorrect Answer (D): Reducing protein intake would harm bone health.** Adequate protein is crucial for maintaining bone matrix integrity. Low protein intake is associated with reduced bone density and slower healing of fractures. While excessive protein without sufficient calcium may pose risks, protein restriction is not a recommended osteoporosis prevention strategy. **Key Takeaways:** - **Bone health requires balance:** Calcium, vitamin D, and protein are critical; caffeine and alcohol should be moderated. - **Misleading choices:** Avoiding vitamin D or protein directly undermines bone strength, while alcohol reduction (though correct) does not align with the question’s framing if seeking incorrect statements. - **Context matters:** The question likely tests recognition of harmful advice (A and D) versus beneficial actions (B and C), but assuming it requests incorrect statements, B stands alone as the accurate selection. **Clarifying Nuances:** - Caffeine’s effect is dose-dependent; moderate intake with adequate calcium may not pose significant risk. - Alcohol’s harm is dose-dependent, but abstinence is not required—moderation is key. - Vitamin D and protein are non-negotiable for bone health; their restriction is never advised. This rationale ensures students understand not just the correct answer but the physiological principles underlying each option, empowering them to apply this knowledge in clinical judgment.

Correct Answer: B

Rationale: The client's report of bilateral, painless blurred vision strongly suggests cataracts as the most likely condition. Cataracts develop when the lens of the eye becomes cloudy, leading to progressive, painless vision impairment that typically affects both eyes (though often asymmetrically). This clouding scatters light entering the eye, causing blurred vision that may be described as looking through a foggy window. Cataracts are particularly associated with aging (age-related cataracts), but can also result from trauma, medications like steroids, or systemic conditions like diabetes. The bilateral presentation without pain aligns perfectly with cataract symptoms, as they rarely cause discomfort unless they reach an advanced stage. Macular degeneration (A) primarily affects central vision rather than causing generalized blurring, and typically presents with specific distortions like straight lines appearing wavy (metamorphopsia) or central scotomas (blind spots). While it can be bilateral, macular degeneration wouldn't typically cause symmetrical blurring without these distinctive features. Retinal detachment (C) usually presents with unilateral symptoms like sudden flashes of light (photopsia), floaters, or a "curtain" over the visual field rather than gradual bilateral blurring. While painless, retinal detachment is typically an acute event with distinct symptoms that differ from the described presentation. Glaucoma (D) in its most common form (open-angle) is indeed painless, but visual changes typically begin with peripheral vision loss, not generalized blurring. Angle-closure glaucoma can cause sudden blurring but is accompanied by severe pain, nausea, and halos around lights, making it inconsistent with this presentation. The key distinguishing factors here are the bilateral nature of symptoms, absence of pain, and the characteristic blurred (rather than lost) vision. Cataracts progress slowly, explaining why the blurring develops gradually without other symptoms. The lens opacity in cataracts affects all light entering the eye uniformly, unlike macular degeneration which targets central vision or glaucoma that attacks peripheral vision first. None of the other options present with this exact combination of features, making cataract the only plausible explanation among the choices given. Additional supporting evidence would include age (most common in those over 60), possible complaints of glare sensitivity, or difficulty with night vision—all hallmark symptoms of cataracts that further confirm this as the correct answer.

Correct Answer: D

Rationale: Open reduction with internal fixation (ORIF) is the most common method for reducing and immobilizing fractures because it provides direct visualization and alignment of bone fragments while offering stable fixation through implants like plates, screws, or rods. This approach ensures anatomical reduction, which is critical for proper healing, especially in displaced or complex fractures. The internal fixation hardware maintains alignment during the healing process, allowing for early mobilization and rehabilitation, reducing complications like malunion or nonunion. ORIF is preferred for intra-articular fractures (where joint surfaces are involved) and comminuted fractures (multiple bone fragments) because it restores function and stability more effectively than external methods. Choice A (Open reduction with external fixation) is incorrect because external fixation is typically reserved for severe open fractures, cases with significant soft tissue damage, or temporary stabilization. While open reduction allows direct visualization, external fixators are bulkier, limit mobility, and carry a higher risk of pin-site infections. They are not as stable as internal fixation for long-term fracture healing and are usually a bridge to definitive treatment rather than the primary method. Choice B (External reduction and internal fixation) is incorrect because "external reduction" is not a standard medical term. Reduction refers to realigning bone fragments, which can only be done through closed (non-surgical) or open (surgical) methods. Pairing "external reduction" with internal fixation is a contradiction—internal fixation requires surgical access, making the phrase nonsensical in clinical practice. Choice C (External fixation with closed reduction) is incorrect because while closed reduction (manipulation without surgery) is less invasive, it is often insufficient for unstable or complex fractures. External fixation alone lacks the precision of internal fixation and may not maintain adequate alignment, leading to poor healing outcomes. This method is more commonly used in emergency settings or for temporary stabilization before ORIF, not as the definitive treatment for most fractures. The superiority of ORIF lies in its ability to combine precise anatomical alignment with robust mechanical stability, facilitating optimal bone healing and functional recovery. Other methods either lack the necessary stability (external fixation) or are misrepresented concepts (external reduction), making them unsuitable as the most common or effective approach.

Correct Answer: D

Rationale: Let’s analyze each choice to understand why **D (All of the Above)** is correct and why the other options, while partially correct, are incomplete on their own. 1. **Wear sunglasses to filter ultraviolet (UV) light (A):** This is a crucial health promotion measure for vision. Prolonged UV exposure can lead to cataracts, macular degeneration, and photokeratitis (sunburn of the cornea). Sunglasses with UV-blocking lenses protect the eyes from these harmful effects. However, this alone does not cover all aspects of eye health promotion. 2. **Avoid nonsteroidal anti-inflammatory drug (NSAID) use (B):** While NSAIDs are generally safe for short-term use, chronic or excessive use can cause ocular side effects, such as dry eye syndrome or, in rare cases, retinal hemorrhages. However, this is a more specific and situational recommendation—not everyone needs to avoid NSAIDs outright. It is a valid point for certain populations, but it’s not universally applicable like other options. 3. **Wash your hands before touching your eyelids (C):** Hand hygiene is essential to prevent infections like conjunctivitis (pink eye) or styes, which can result from transferring bacteria or viruses to the eyes. This is a fundamental practice for maintaining eye health, but similar to the other options, it’s only one part of a comprehensive strategy. **Why D (All of the Above) is correct:** Each option (A, B, and C) represents a valid health promotion measure for vision, but none alone cover all necessary precautions. Sunglasses protect against environmental damage, NSAID avoidance prevents medication-related risks, and handwashing reduces infection risks. Combining these measures ensures a holistic approach to eye health, addressing multiple potential threats. **Why A, B, or C alone are insufficient:** - Choosing **only A** neglects infection prevention (C) and medication risks (B). - Choosing **only B** ignores UV protection (A) and hygiene (C). - Choosing **only C** disregards environmental and medication-related risks (A and B). Thus, the most comprehensive and correct answer is **D**, as it integrates all three critical aspects of vision health promotion.