A nurse is assessing a client who is in skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin sites?
Mild erythema
Serosanguineous drainage
Fever
Warmth
The Correct Answer is C
A. Mild erythema (redness) at the pin sites can be a normal finding due to the body's response to the presence of foreign objects. It may not necessarily indicate infection.
B. Serosanguineous drainage (a mixture of clear and bloody fluid) can also be a normal finding initially after the insertion of pins. It may not necessarily indicate infection.
C. Fever is a systemic response to infection. In a client with skeletal traction, fever can be an indication of an infection at the pin sites or a more systemic infection related to the traction device.
D. Warmth around the pin sites can be a normal finding due to the inflammatory response that occurs after pin insertion. It may not necessarily indicate infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["43.2"]
Explanation
- To calculate the dose of enoxaparin, first convert the client's weight from pounds to kilograms by dividing by 2.2.
- 95 lbs / 2.2 = 43.18 kg
- Then, multiply the weight in kilograms by the prescribed dose of 1 mg/kg. - 43.18 kg x 1 mg/kg = 43.18 mg
- Finally, round the answer to the nearest tenth of a milligram.
- 43.18 mg ≈ 43.2 mg
- Therefore, the nurse should administer 43.2 mg of enoxaparin per dose subcutaneously every 12 hours.
Correct Answer is C
Explanation
A. Russell's traction does not use skeletal pins. Skeletal traction involves the use of pins, wires, or screws inserted directly into the bone to stabilize a fracture.
B. Russell's traction does not involve the use of a pelvic girdle belt. Pelvic girdle belts are more commonly associated with some other forms of traction used for different purposes.
C. Russell's traction is specifically used for the treatment of a fracture of the femur, and it involves a sling placed under the knee to support and immobilize the affected leg.
D. Russell's traction is not used to decrease cervical muscle spasms. Cervical traction, using a cervical halter, is a separate form of traction used for cervical spine-related issues.
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