A nurse is caring for a client who has skeletal traction for the treatment of a femur fracture.
Which of the following actions should the nurse take?
Position the weights on the traction so they are touching the head of the client's bed
Encourage isometric exercises every 8 hr
Administer pain medication to the client before performing pin care
Assist the client to shift position every 4 hr.
The Correct Answer is D
The nurse should assist the client to shift position every 4 hours to prevent complications such as pressure ulcers and pneumonia.
Choice A is incorrect because the weights on the traction should be freely hanging and not touching any part of the bed.
Choice B is incorrect because isometric exercises may not be appropriate for a client with a femur fracture and should be prescribed by a healthcare provider.
Choice C is incorrect because administering pain medication before performing pin care may not be necessary and should be based on the client’s level of pain and the healthcare provider’s orders.
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Related Questions
Correct Answer is B
Explanation
Radiographs are vital to the diagnosis of Legg-Calve-Perthes disease.
Initial X-rays might look normal because it can take one to two months after symptoms begin for the changes associated with Legg-Calve-Perthes disease to become evident on X-rays.
The doctor will likely recommend several X-rays over time, to track the progression of the disease.
Bone biopsy is not a diagnostic procedure for Legg-Calve-Perthes disease.
MRI can visualize bone damage caused by Legg-Calve-Perthes disease more clearly than X-rays can but are not always necessary.
Genetic testing is not a diagnostic procedure for Legg-Calve-Perthes disease.
Correct Answer is B
Explanation
The nurse should teach the patient to report promptly any edema of the face and hands.
Edema of the face and hands can be a sign of preeclampsia, a serious pregnancy complication that can lead to high blood pressure and damage to organs such as the liver and kidneys.
Preeclampsia can be dangerous for both the mother and the baby and requires prompt medical attention.
Choice A is not an answer because nasal congestion is a common symptom during pregnancy and is not considered a danger sign.
Choice C is not an answer because hemorrhoids are also a common symptom during pregnancy and are not considered a danger sign.
Choice D is not an answer because varicose veins are also a common symptom during pregnancy and are not considered a danger sign.
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