Which assessment finding should you report immediately for a patient with fractures of the medial ulna and radius?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) The patient complains of pressure and pain. This finding should be reported immediately because it could indicate compartment syndrome, a serious condition where increased pressure within a muscle compartment compromises blood flow and can lead to tissue damage. Prompt intervention is crucial to prevent long-term complications. Option B) The cast being dry and intact is a positive finding but not as urgent as the patient's complaint of pressure and pain. It indicates proper initial care of the fractures. Option C) The skin being pink and warm to touch is a good sign of adequate circulation, but it does not address the patient's complaint of pressure and pain, which takes precedence. Option D) The patient being able to move all fingers and thumb is also a positive finding but does not address the immediate concern of pressure and pain, which could signal a serious complication. In an educational context, this question highlights the importance of prioritizing patient assessments based on potential complications. Understanding the signs and symptoms of conditions like compartment syndrome is crucial for nurses to provide timely and appropriate care to prevent further harm to the patient. This knowledge is essential for nurses preparing for the NCLEX exam and in their clinical practice to ensure patient safety and well-being.

Correct Answer: B

Rationale: Intracranial pressure management is a critical aspect of postoperative care following intracranial surgery. Mannitol is the correct drug choice to decrease intracranial pressure in this scenario. Mannitol is an osmotic diuretic that works by drawing fluid out of brain tissue and into the bloodstream, thereby reducing cerebral edema and intracranial pressure. Benadryl (A) is an antihistamine and is not indicated for reducing intracranial pressure post-surgery. Prednisone (C) and corticosteroids (D) are anti-inflammatory drugs that are not primarily used to decrease intracranial pressure in this context. Educationally, understanding the rationale behind the choice of Mannitol reinforces the pharmacological principles of osmotic diuretics and their application in managing intracranial pressure. This knowledge is crucial for nursing practice, especially in neurosurgical and critical care settings where prompt and accurate interventions are essential for patient outcomes.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Touch, deep pressure, vibration, and position sense. The fasciculus gracilis and fasciculus cuneatus are ascending pathways in the spinal cord responsible for transmitting sensory information such as touch, deep pressure, vibration, and position sense from the body to the brain. If there is a lesion affecting these pathways, the patient would likely experience a loss of these specific sensory modalities. Option A) Pain and temperature sensations are carried by the spinothalamic tract, which is separate from the fasciculus gracilis and fasciculus cuneatus. Therefore, this option is incorrect. Option C) Subconscious information about body position and muscle tension is primarily mediated by the spinocerebellar tracts, not the fasciculus gracilis and fasciculus cuneatus. Hence, this option is incorrect. Option D) Voluntary muscle control from the cerebral cortex to the peripheral nerves involves the corticospinal tracts, which are also distinct from the pathways affected by a lesion in the fasciculus gracilis and fasciculus cuneatus. Therefore, this option is incorrect. Understanding the specific functions of different spinal cord pathways is crucial for healthcare professionals, especially nurses, in assessing and interpreting sensory deficits in patients. This knowledge helps in providing appropriate care and interventions to address the patient's needs effectively.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Gamma knife radiosurgery. Gamma knife radiosurgery is a non-invasive procedure that uses precise radiation to target the trigeminal nerve, effectively reducing pain associated with trigeminal neuralgia. It has the least residual effects compared to other surgical interventions, as it does not involve invasive techniques or the risks associated with open surgery. Option A) Glycerol rhizotomy involves injecting glycerol into the trigeminal nerve, which can provide relief but may have more side effects compared to gamma knife radiosurgery. Option C) Microvascular decompression is a more invasive surgical procedure that involves moving blood vessels away from the trigeminal nerve. It has a higher risk of complications and longer recovery time compared to gamma knife radiosurgery. Option D) Percutaneous radiofrequency rhizotomy involves using heat to damage the trigeminal nerve, which can provide relief but may have more side effects and potential for nerve damage compared to gamma knife radiosurgery. Educationally, understanding the different surgical interventions for trigeminal neuralgia is crucial for nurses caring for patients with this condition. Knowledge of the least invasive and most effective treatments allows nurses to provide informed care and support to patients undergoing these procedures.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Heart rate of 42 bpm. When a patient sustains a spinal cord injury at the level of T2, it can lead to autonomic dysreflexia, a potentially life-threatening condition. A sudden increase in blood pressure can stimulate the vagus nerve, causing bradycardia (slow heart rate). This response is a critical indication of autonomic dysreflexia. Option A) SpO2 of 92% is suboptimal but does not pose an immediate threat compared to a bradycardia. Option C) Blood pressure of 88/60 mm Hg is low but can be a normal response to the injury and not as concerning as the bradycardia. Option D) Loss of motor and sensory function in arms and legs, while significant, is an expected outcome of a spinal cord injury at T2 and is not as acutely dangerous as bradycardia in this context. Educationally, understanding the specific complications of spinal cord injuries, such as autonomic dysreflexia, is crucial for nurses caring for these patients. Recognizing the signs and symptoms of autonomic dysreflexia promptly is vital to prevent severe complications and provide timely interventions. This question highlights the importance of prioritizing assessments based on the potential for immediate harm in patients with spinal cord injuries.