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: **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: 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.

Correct Answer: A

Rationale: A **sprain** is the correct answer because it specifically refers to the excessive stretching or tearing of a ligament, which is the fibrous connective tissue that connects bones to each other at a joint. Sprains occur when a joint is forced beyond its normal range of motion, causing the ligament to overstretch or partially/completely tear. Common examples include ankle sprains from rolling the foot or knee sprains from sudden twists. The severity of a sprain is graded from I (mild stretching) to III (complete rupture), but the core definition aligns with ligament overstretching. **B: Ligament tear** is incorrect because while a sprain can involve a tear, this option is too narrow. A "ligament tear" typically implies a complete rupture (Grade III sprain), whereas the question asks about *excessive stretching*, which encompasses milder forms of ligament injury (Grades I-II). A tear is a subset of sprains, not a synonym. **C: Strain** is incorrect because it describes an injury to a muscle or tendon (which connects muscle to bone), not a ligament. Strains result from overstretching or tearing muscle fibers or tendons, often due to sudden force or overuse (e.g., hamstring strains). The key distinction lies in the anatomical structure affected: strains involve muscle-tendon units, while sprains involve ligaments. **D: Tendon rupture** is incorrect because it refers specifically to the complete severing of a tendon, which is entirely different from ligament stretching. Tendon ruptures (e.g., Achilles tendon) are acute injuries often requiring surgical repair, whereas ligament overstretching (sprain) may heal with conservative treatment. The question’s focus on ligaments makes this option anatomically irrelevant. The confusion often arises from the similarity in symptoms (pain, swelling) between sprains and strains, but the critical difference lies in the affected tissue. Ligaments stabilize joints; muscles and tendons generate movement. Understanding this anatomical distinction clarifies why "sprain" is the only correct answer for ligament-related overstretching. Additionally, grading systems for sprains account for varying degrees of ligament damage, while the other choices either misrepresent the tissue (strain, tendon rupture) or overspecify the injury (ligament tear).

Correct Answer: A

Rationale: To convert milliliters (ml) to fluid ounces (oz), you must know the conversion factor: **1 fluid ounce is approximately equal to 29.5735 milliliters**. Using this, you can calculate the equivalent of 30 ml in ounces by dividing the volume in milliliters by the conversion factor. **Calculation:** \[ \text{Ounces} = \frac{\text{Milliliters}}{29.5735} = \frac{30}{29.5735} \approx 1.014 \, \text{oz} \] Since the question asks for the answer as a numeric value without decimals, we round to the nearest whole number, which is **1 oz**. **Why A (1) is Correct:** The exact conversion of 30 ml is approximately 1.014 oz, which rounds to **1 oz** when considering whole numbers. This makes **A** the most accurate choice among the options provided. **Why B (2) is Incorrect:** 2 oz would correspond to roughly **59.147 ml** (since \(2 \times 29.5735 = 59.147\)), which is nearly double the given 30 ml. This overestimates the conversion significantly. **Why C (3) is Incorrect:** 3 oz would be approximately **88.7205 ml** (since \(3 \times 29.5735 = 88.7205\)), which is almost three times the original volume of 30 ml. This is far too large and not a plausible conversion. **Why D (4) is Incorrect:** 4 oz would equal about **118.294 ml** (since \(4 \times 29.5735 = 118.294\)), which is nearly four times the given 30 ml. This is a gross overestimation and not mathematically correct for the conversion. In summary, **A (1)** is correct because it aligns with the precise conversion factor when rounded to the nearest whole number, while the other options are incorrect due to their substantial deviations from the actual calculated value. Understanding unit conversions requires knowing the exact relationship between the units and applying basic arithmetic to ensure accuracy.