Question

The nurse is rendering first aid at the scene of a motor vehicle accident. Before moving a client with an apparent fracture of lower leg, the nurse should give priority to: A. Removing the client's shoes to see whether there is trauma to the foot B. Immobilizing the extremity by splinting the joint above and below the fracture C. Keeping the client in a semi-sitting position D. Checking the neurovascular status of the area distal to the fracture

Short answer

Answer: B. Immobilizing the extremity by splinting the joint above and below the fracture.

Step-by-step solution

Evaluate each option

Let's analyze each option given in the question before choosing which one the nurse should prioritize: A. Removing the client's shoes to see whether there is trauma to the foot: While checking for additional injuries is important, prioritizing the removal of shoes to inspect the foot may not be the most urgent action. B. Immobilizing the extremity by splinting the joint above and below the fracture: Immobilizing the fractured limb can help prevent further injury and reduce pain. This option seems like a likely priority in this scenario. C. Keeping the client in a semi-sitting position: Changing the position of the client may not be the most urgent action to take, especially if their leg is fractured. D. Checking the neurovascular status of the area distal to the fracture: While monitoring neurovascular status is crucial, it might not be the top priority compared to immobilizing the extremity to prevent further injury.

Determine the priority action

Based on our evaluation of each option, immobilizing the extremity by splinting the joint above and below the fracture (Option B) seems to be the most important action to prioritize in this scenario. Thus, the correct answer is: B. Immobilizing the extremity by splinting the joint above and below the fracture

Key concepts

First Aid for Fractures

Understanding the basics of first aid for fractures is essential for any healthcare provider, including those preparing for the NCLEX-PN exam. When encountering a fracture, the primary goal is to prevent further injury and facilitate healing. It's crucial to keep the injured area as still as possible and provide support until medical care can be administered.

First, assess the situation for any immediate dangers and ensure it is safe to approach the injured individual. Call for emergency medical assistance if needed. If an open wound is present, cover it with clean cloth to reduce the risk of infection. Avoid moving the person excessively, as movement can exacerbate the injury and cause intense pain.

Only after ensuring the person is stable and there are no life-threatening conditions, should you proceed with addressing the fracture. Remember, in a multiple-trauma situation, life-saving interventions take precedence over fracture management.

Immobilizing Extremities

One of the most critical steps in managing fractures is immobilizing the affected extremity. This stabilizes the area, prevents further damage to the surrounding tissues, and reduces pain and swelling. The nurse should use a splint to immobilize the joint above and below the site of the fracture.

It's important not to attempt realignment of the fractured bone, as this could potentially cause more harm. Immobilization should be done gently and carefully. Padding can be used to provide support and reduce discomfort. If a commercial splint is not available, improvise with available materials such as boards, folded magazines, or blankets.

During immobilization, it's imperative to check the extremity for any signs of impaired circulation or nerve damage both before and after splinting. This ensures that the immobilization has not exacerbated any issues with the limb's blood supply or sensory functions.

Nursing Priorities

In any emergency situation, including fractures, a nurse must quickly identify and execute nursing priorities to safeguard the patient's wellbeing. These priorities typically follow the principles of the ABCs (airway, breathing, circulation), immediate safety, and then injury-specific interventions.

In the scenario of a fracture, after confirming that the patient has a patent airway, is breathing adequately, and has stable circulation, the priority moves to preventing further injury. This is why immobilizing the fracture effectively is a top nursing action. Nevertheless, care should be balanced against the need to manage pain, monitor for signs of shock, and maintain overall patient comfort.

In the context of the NCLEX-PN exam, candidates must demonstrate their ability to quickly identify these priorities and apply them to a variety of patient care scenarios, ensuring the safest and most beneficial outcomes for patients.

Neurovascular Status Assessment

Assessing the neurovascular status of an extremity with a suspected or confirmed fracture is a key component of patient care. This involves checking for circulation, sensation, and movement. Assessing neurovascular status helps determine if there has been any compromise to the nerves or blood vessels around the injury site, which could lead to serious complications if left unaddressed.

The assessment includes evaluating peripheral pulses, skin color and temperature, capillary refill time, and the presence of any numbness, tingling, or inability to move the affected limb. This should be done promptly and periodically after any intervention, such as immobilization, to ensure that the intervention has not negatively impacted neurovascular function.

Nurses preparing for the NCLEX-PN exam must understand how to conduct a thorough neurovascular examination and recognize the signs of neurovascular compromise, which could signify a need for immediate medical evaluation and possibly adjustment of the immobilization technique.