A nurse is collecting data from a client who has skeletal traction.
Which of the following findings should the nurse identify as an indication of infection at the pin sites?
Warmth.
Mild erythema.
Serosanguineous drainage.
Fever.
The Correct Answer is D
Fever is a sign of infection and can indicate that there is an infection at the pin sites.
Choice A is not correct because warmth can be a normal finding at the pin sites.
Choice B is not correct because mild erythema can be a normal finding at the pin sites.
Choice C is not correct because serosanguineous drainage can be a normal finding at the pin sites.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
E. The nurse should ensure the scale is balanced prior to use [A], place a disposable covering on the scale [B], weigh the infant in a diaper [D], and measure the infant from the crown of the head to the heels of the feet [E].
Choice C is incorrect because a stadiometer is used to measure standing height and is not appropriate for measuring the length of an infant who cannot stand.
Correct Answer is D
Explanation
On average, by 3 years of age, children can walk up and down stairs, one foot per step, with no support.
Choice A is incorrect because it is not developmentally appropriate for a 4-year-old child to place both feet on each step and hold on to the railing while descending stairs.
Choice B is incorrect because it is not developmentally appropriate for a 6-year-old child to place both feet on each step and hold on to the railing while descending stairs.
Choice C is incorrect because it is not developmentally appropriate for a 5-year-old child to place both feet on each step and hold on to the railing while descending stairs.
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