The nurse is assessing a patient in skin traction. Which finding indicates the need for immediate intervention?

The patient's skin under the traction tape is pink and intact.

The patient reports mild discomfort at the traction site.

The traction weight is correctly calibrated and suspended freely.

The patient's toes are warm, and capillary refill time is less than 2 seconds.

Answer and Explanation

The Correct Answer is B

While mild discomfort may seem minor, it could indicate skin breakdown, pressure injury, or neurovascular compromise. The nurse must immediately assess circulation, sensation, and motion (CSM) in the affected limb to rule out complications such as compartment syndrome, nerve compression, or improper traction alignment.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

Using a clear and concise verbal report is an effective approach to nursing communication. It allows for the efficient transfer of essential patient information to the healthcare provider.

a. Sending a text message to the healthcare provider may not be appropriate for discussing patient information as it may not be secure and may lack important details.

b. Speaking in medical jargon during the conversation can lead to miscommunication and misunderstandings between the nurse and the healthcare provider.

d. Providing the healthcare provider with outdated patient data is not effective in patient care and may lead to incorrect decision-making.

A. Assessing the skin under the traction tape every 8 hours. B. Tightening the traction ropes to increase the traction force. C. Placing the traction weights on the bed rather than suspending them. D. Removing the traction periodically to allow the skin to breathe.

Correct Answer is A

Explanation

Option A is appropriate because assessing the skin under the traction tape helps monitor for any signs of skin breakdown, irritation, or pressure ulcers. Regular skin assessments are essential to prevent complications related to skin traction.

b. Tightening the traction ropes to increase the traction force is incorrect. The traction force should be set by the healthcare provider, and altering it without proper authorization may lead to adverse effects or further injury.

c. Placing the traction weights on the bed instead of suspending them is incorrect. Traction weights should be suspended freely to provide the appropriate traction force and maintain proper alignment of the fractured bone.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse is assessing a patient in skin traction. Which finding indicates the need for immediate intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient in skin traction. When communicating with the healthcare provider about the patient's condition, which approach demonstrates effective nursing communication?

Correct Answer is C

Explanation

The nurse is caring for a patient with a fractured femur in skin traction. Which action by the nurse is appropriate?

Correct Answer is A

Explanation

The nurse is assessing a patient with skin traction. Which finding requires immediate intervention?

The nurse is providing discharge teaching to a patient with skin traction. What instruction should the nurse include to promote skin integrity?

Which statement best describes skin traction in nursing practice?

The nurse is evaluating the skin condition of a patient in skeletal traction. Which finding requires immediate intervention?

The nurse is caring for a patient in skin traction. What is a potential complication of skin traction if not properly secured?

The nurse is evaluating the patient's neurovascular status in skin traction. Which finding indicates a potential complication?

The nurse is caring for a patient with skin traction. What is a potential complication of skin traction?

The nurse is caring for a patient with a fractured femur who has been placed in skin traction. Which action should the nurse take to prevent skin breakdown?