Author Question: A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is ... (Read 44 times)

piesebel · **on:** Jun 25, 2018

A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is administered, the client reports pain in the site of the fracture. Which actions should the nurse take? (Select all that apply.)

a. Administer additional opioids as prescribed.
b. Elevate the extremity on pillows.
c. Apply ice to the fracture site.
d. Place a heating pad at the site of the injury.
e. Keep the extremity in a dependent position.

Question 2

An emergency nurse assesses a client who is admitted with a pelvic fracture. Which assessments should the nurse monitor to prevent a complication of this injury? (Select all that apply.)

a. Temperature
b. Urinary output
c. Blood pressure
d. Pupil reaction
e. Skin color

lorealeza77 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: A, B, C
The client with a new fracture likely has edema; elevating the extremity and applying ice probably will help in decreasing pain. Administration of an additional opioid within the dosage guidelines may be ordered. Heat will increase edema and may increase pain. Dependent positioning will also increase edema.

Answer to Question 2

ANS: B, C, E
With a pelvic fracture, internal organ damage may result in bleeding and hypovolemic shock. The nurse monitors the client's heart rate, blood pressure, urine output, skin color, and level of consciousness frequently to determine whether shock is manifesting. It is important to monitor the urine for blood to assess whether the urinary system has been damaged with the pelvic fracture. Changes in temperature and pupil reactions are not directly associated with hypovolemic shock. Temperature changes are usually associated with hypo- or hyperthermia or infectious processes. Pupillary changes occur with brain injuries, bleeds, or neurovascular accidents.