The nurse has arrived for the scheduled shift. After receiving bedside report and making the initial rounds on the assigned clients, which client should the nurse plan to care for first?

Choice A reason: Males with a cardiac history between the ages of 30 and 40 years old are not the most at risk for developing osteoporosis, as they have several protective factors, such as their gender, age, and hormone levels. Males have higher peak bone mass and lower bone loss rate than females, and they do not experience the rapid decline of estrogen that occurs after menopause. Cardiac history may affect the bone health indirectly, by limiting the physical activity or affecting the calcium absorption, but it is not a major risk factor.

Choice B reason: Females with a history of diabetes and are between the ages of 20 and 30 years old are not the most at risk for developing osteoporosis, as they have some protective factors, such as their age and hormone levels. Females in their reproductive years have higher estrogen levels than post-menopausal females, which helps to preserve the bone density and prevent the bone resorption. Diabetes may increase the risk of osteoporosis, by affecting the insulin, glucose, and inflammatory pathways, but it is not a definitive risk factor.

Choice C reason: Males who have had a previous fracture are not the most at risk for developing osteoporosis, as they have some protective factors, such as their gender and hormone levels. Males have higher peak bone mass and lower bone loss rate than females, and they do not experience the rapid decline of estrogen that occurs after menopause. A previous fracture may indicate a low bone density or a high fall risk, but it is not a conclusive risk factor.

Choice D reason: Females who have a history of estrogen deficiency and are post-menopausal are the most at risk for developing osteoporosis, as they have several risk factors, such as their gender, age, and hormone levels. Females have lower peak bone mass and higher bone loss rate than males, and they experience a significant drop of estrogen after menopause, which leads to increased bone resorption and decreased bone formation. Estrogen deficiency may also cause other symptoms, such as hot flashes, mood swings, or vaginal dryness, which may affect the quality of life and the bone health.

Choice A reason: Providing cast care to bilateral lower extremities is not an action that would be included in the nurse's plan of care for a client in skeletal traction, as it is not relevant to the type of traction. Skeletal traction involves the insertion of pins, wires, or screws into the bone, and does not require a cast. Cast care is more applicable to clients in plaster or fiberglass casts.

Choice B reason: Instituting measures to prevent skin breakdown is an action that would be included in the nurse's plan of care for a client in skeletal traction, as it is a potential complication of prolonged immobilization and pressure. The nurse should inspect the skin regularly, change the bed linens frequently, use pressure-relieving devices, and encourage the client to shift positions as much as possible.

Choice C reason: Cleaning the pins every hour with peroxide to prevent infection is not an action that would be included in the nurse's plan of care for a client in skeletal traction, as it is excessive and harmful. The nurse should follow the facility's protocol for pin site care, which usually involves cleaning the pins once or twice a day with a mild antiseptic solution, such as chlorhexidine or saline. Peroxide is not recommended, as it can damage the tissue and delay the healing.

Choice D reason: Placing the client on contact precautions is not an action that would be included in the nurse's plan of care for a client in skeletal traction, as it is not indicated for this type of traction. Contact precautions are used for clients who have infections that can be transmitted by direct or indirect contact, such as MRSA, VRE, or C. difficile. Skeletal traction does not pose a high risk of infection, unless there is a pin site infection or osteomyelitis.

Choice E reason: Maintaining proper alignment and position of the traction is an action that would be included in the nurse's plan of care for a client in skeletal traction, as it is essential for the effectiveness and safety of the traction. The nurse should ensure that the traction is applied correctly, that the weights are hanging freely, that the ropes are not twisted or frayed, and that the pulleys are not obstructed. The nurse should also avoid lifting or moving the weights, as it can alter the traction force and cause complications.